Liverpool COVID-19 Interactions

Do Not Coadminister

Nirmatrelvir/ritonavir (5 days)

Ivosidenib

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied and is contraindicated. Ivosidenib is primarily metabolized by CYP3A4. Nirmatrelvir/ritonavir is a strong inhibitor of CYP3A4 and is expected to significantly increase ivosidenib exposure and increase the risk of serious adverse events. In addition, ivosidenib is a strong inducer of CYP3A4 and may cause large decreases in nirmatrelvir/ritonavir concentrations which may in turn significantly decrease the nirmatrelvir/ritonavir therapeutic effect. Due to the persisting effect upon discontinuation of a strong inducer, consider an alternative COVID-19 treatment.

Description:

Serum concentrations of ivosidenib may be increased when coadministered with ritonavir which may increase the risk of toxicity, including the risk of serious adverse events such as QT interval prolongation. Avoid coadministration of . If the benefit is considered to outweigh the risk and ritonavir must be used, patients should be carefully monitored for safety.

Paxlovid EU Summary of Product Characteristics, Pfizer, February 2025.

Ivosidenib concentrations may be increased. Avoid co-administration of ivosidenib due to potential risk of serious adverse events such as QT interval prolongation. For further information, refer to individual product label for anticancer drug.

Paxlovid US Prescribing Information, Pfizer Inc, February 2025.