Taseal AHMED
Eurasian Clinical and Analytical Medicine - 2026;14(2):38-42
Aim: Nirmatrelvir/ritonavir is an oral antiviral for high-risk outpatients with COVID-19, yet ritonavir-mediated drug-drug interactions can preclude use or require mitigation, delaying time-sensitive therapy. We estimated the national prevalence of significant Paxlovid drug-drug interactions in U.S. adults. Methods: We conducted a cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 pre-pandemic data. Prescription medications were mapped at the ingredient level to the Food and Drug Administration (FDA) Paxlovid Fact Sheet interaction table and classified as Tier 1 (contraindicated) or Tier 2 (avoid/temporary holding, dose adjustment, or monitoring). Using NHANES complex survey methods, we estimated weighted prevalence and 95% confidence intervals (CI) for exposure. A sensitivity analysis was restricted to interviewer-observed medications (prescription medication seen variable [RXQSEEN] = 1). Polypharmacy was defined as >=5 prescription medications. Results: Among 9,693 adults, the weighted prevalence of exposure to any Tier 1 contraindicated medication was 6.88% (95% CI, 5.63-8.13), Tier 2 exposure was 27.74% (95% CI, 26.04-29.44), and any Tier 1 or Tier 2 exposure was 31.19% (95% CI, 29.15-33.22). In the RXQSEEN-restricted sensitivity analysis, prevalence estimates were 6.08% (Tier 1), 24.86% (Tier 2), and 28.05% (any Tier 1 or Tier 2). Among adults with polypharmacy, prevalence was 22.36% (Tier 1), 79.54% (Tier 2), and 86.50% (any Tier 1 or Tier 2). Simvastatin was the most common Tier 1 ingredient (4.27%). Conclusion: Potential clinically significant Paxlovid drug-drug interactions are common in U.S. adults and highly prevalent among those with polypharmacy, underscoring the central role of clinical pharmacy in rapid medication reconciliation, interaction mitigation, and timely access to COVID-19 therapeutics.
