I caught covid last March. Although tortuous, the 111, NHS royte worked for me and I received the sotrovimab infusion in my local hospital. 111 had passed my info onto the team response team and a pharmacist contacted me promptly. She wanted to give me paxlovid but reading my notes as we spoke she said she wasn't sure I was eligible because of heart drugs I had been prescribed earlier this year.
I had gone to A&E with chest pains and they did all the tests and admitted me for three days. An angiogram revealed build ups on some arteries that did not need a stent or any more dramatic action but did require the full range of drugs for high blood pressure, chloresterol, platelets etc.
Researching the drugs I have been taking the only one that seems to be in conflict with the administration of paxlovid is Atorvastatin. I am not being treated for CLL, I am still on W&W.
Has anyone else been told that they are not suitable for paxlovid?
I have contacted my cardio specialist by email and he has referred the whole enquiry to my GP. Much as I love my doctor I can't see how he has the specialist knowledge to answer my queries.
I am worried now that sotrovimab will be removed from the list of treatments and paxlovid will be much easier to receive.
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Harvist
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I'm not medically trained, but the medical experts that advise me indicate that the issue comes from Paxolovid interacting with a protein CYP3A, and that makes some other drugs we take, become more powerful or last longer in our bodies.
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So in my case, my CLL expert doctor would have me pause taking Calquence for 5-7 days while I was on Paxlovid.
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You should ask your doctor if you can pause the Atorvastatin for the 5 days that you would be taking Paxlovid.
There are several very good drug interaction sites that give this advice
Statins are common medications that lower high cholesterol. Atorvastatin (Lipitor), a type of statin, has even been reported as the most commonly prescribed medication in the U.S.
While statins are popular at pharmacies, they’re not so agreeable when it comes to interacting with other medications. Paxlovid is no exception to this. Paxlovid can block an enzyme responsible for breaking down statins, causing them to linger in your body. This can worsen the risk of side effects, such as muscle pain. In rare cases, rhabdomyolysis (intense muscle breakdown) is also possible.
If you take atorvastatin or rosuvastatin (Crestor), you should avoid taking them while you’re taking Paxlovid.
If you take simvastatin (Zocor, FloLipid) or lovastatin, there’s a stricter recommendation. You should stop taking them 12 hours before your first dose of Paxlovid. After this, you should keep avoiding them until 5 days have passed since your last dose of Paxlovid.
While the following list might not apply to you, the question you ask is one important for all of us to be aware of--and there are other cardio drugs as the American College of Cardiology site has listed which may apply to other members.
The review provides an in-depth overview of a variety of cardiovascular medications used to treat many forms of heart disease. Five of the most important cardiovascular drug interactions with Paxlovid to be aware of include:
Antiarrhythmic agents
Antiarrhythmic agents are used to manage abnormal heart rhythm. Many of these drugs are metabolized in a way that increases plasma levels when co-administered with Paxlovid. While it may be possible to start Paxlovid after 2-2.5-day temporary discontinuation of the antiarrhythmic agents, this may not be feasible from a practical standpoint. Clinicians are advised to consider alternative COVID-19 therapies and avoid co-administration of these agents with Paxlovid.Sotalol, another antiarrhythmic agent, is renally cleared and does not interact with Paxlovid.
Antiplatelet agents and anticoagulants
Antiplatelet agents are used for the treatment of coronary artery disease, particularly if a patient has received a stent. Aspirin and prasugrel are safe to co-administer with Paxlovid. There is an increased risk of blood clots when Paxlovid is given alongside clopidogrel and an increased risk of bleeding when given with ticagrelor. When possible, these agents should be switched to prasugrel. If patients have contraindication to taking prasugrel, then co-administration of Paxlovid should be avoided and alternative COVID-19 therapies should be considered.
Anticoagulants, or blood thinners used to treat or prevent blood clots, such as warfarin may be co-administered with Paxlovid but require close monitoring of clotting factors in bloodwork. The plasma levels of all direct oral anticoagulants increase when co-administered with Paxlovid, therefore dose adjustment or temporary discontinuation and use of alternative anticoagulants may be required.
Certain statins
Co-administration of simvastatin or lovastatin with Paxlovid can lead to increased plasma levels and subsequent muscle weakness (myopathy) and rhabdomyolysis, a condition in which the breakdown of muscle tissue releases a damaging protein into the bloodstream. These agents should be stopped prior to initiation of Paxlovid. A dose reduction of atorvastatin and rosuvastatin is reasonable when co-administered with Paxlovid. The other statins are considered safe when given along with Paxlovid.
Ranolazine
Plasma concentration of ranolazine, used to treat angina and other heart-related chest pain, is exponentially increased in the presence of CPY450 inhibitors like Paxlovid, thereby increasing the risk of clinically significant QT prolongation and torsade de pointes (a type of arrhythmia). Co-administration of Paxlovid is therefore contraindicated. Temporary discontinuation of ranolazine is advised if prescribing Paxlovid.
Immunosuppressive agents
The plasma levels of immunosuppressive agents prescribed for patients who have undergone heart transplantation exponentially rise to toxic levels when co-administered with Paxlovid. Temporary reduction of dosing of immunosuppressive agents would require frequent monitoring and be logistically difficult. Therefore, alternative COVID-19 therapies should be considered in these patients.
This is interesting because when my husband and I got Covid, I was given beblitovomab and my husband Paxlovid. I was surprised (and very glad she checked my drug list) that the person who signed me up for the treatment for Covid said I shouldn't have Paxlovid because of being on Venetoclax. Apparently Paxlovid can also have consequences with Venetoclax as other's have noted, essentially increasing the dosage of the Venetoclax. I would not have known that and I haven't heard that anywhere before.
So when my husband started taking Paxlovid he got severe muscle cramps. I remembered what the pharmacist said about it for my situation and it dawned on me that it might interact with the Statin my husband is on as well. Thank goodness I checked and he stopped taking the statin and began to feel better. This time google helped!
Now since I am on a beta blocker I most likely will need to check with my doctors if I ever need Paxlovid myself as apparently that is one of the only treatments we may have for awhile.
I hope that info helps Harvist as we navigate all these health situations! Best to you.
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