Concomitant Use of SYMTUZA with Paxlovid™ (nirmatrelvir tablets and ritonavir tablets)

SUMMARY

• Currently, there are no published data evaluating the concomitant use of SYMTUZA and Paxlovid.^1,2
• According to the Paxlovid Prescribing Information, patients on ritonavir- or cobicistat-containing HIV regimens should continue their treatment as indicated.²

CLINICAL DATA

• There are no published data evaluating the concomitant use of SYMTUZA and Paxlovid, which is nirmatrelvir tablets co-packaged with ritonavir (100 mg) tablets.^1,2
• According to the SYMTUZA Prescribing Information, SYMTUZA is a complete regimen for HIV-1 infection and co-administration with other antiretroviral medications for the treatment of HIV-1 infection is not recommended. Drug-drug interaction studies with other antiretroviral medications such as ritonavir were not conducted.¹
• According to the Paxlovid Prescribing Information, patients on ritonavir- or cobicistat-containing HIV regimens should continue their treatment as indicated. Monitor for increased Paxlovid or protease inhibitor adverse events.²

GUIDANCE DOCUMENTS

There are several resources that provide guidance for managing potential DDIs with ritonavir-boosted nirmatrelvir. These resources advise providers to exercise clinical judgement to assess the risks and benefits of therapy when managing patients on a case-by-case basis.

• Drug-Drug Interactions Between Ritonavir-Boosted Nirmatrelvir (Paxlovid) and Concomitant Medications. Last Updated: February 29, 2024. In: COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at: Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.
• Ontario COVID-19 Drugs and Biologics Clinical Practice Guidelines Working Group, University of Waterloo School of Pharmacy. Nirmatrelvir/Ritonavir (Paxlovid): What prescribers and pharmacists need to know. Ontario COVID-19 Science Advisory Table. 2022;3(58). https://doi.org/10.47326/ocsat.2022.03.58.3.0
• University of Liverpool. COVID-19 Drug Interactions. Available at: https://www.covid19-druginteractions.org/checker, Accessed 03 November 2022.
• Infectious Disease Society of America. Management of Drug Interactions with Nirmatrelvir/Ritonavir (Paxlovid): Resource for Clinicians. Last Updated: May 6, 2022. Available at: https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/management-of-drug-interactions-with-nirmatrelvirritonavir-paxlovid/

LITERATURE SEARCH

A literature search of MEDLINE^®, Embase^®, BIOSIS Previews^®, and Derwent Drug File (and/or other resources, including internal/external databases) pertaining to this topic was conducted on 06 August 2025.