recipients and the potential drug-drug interactions between ritonavir-boosted nirmatrelvir and certain immunosuppressants that are used in these patients. May 13, 2022 Ritonavir-Boosted Nirmatrelvir (Paxlovid) The guidance on identifying and managing drug-drug interactions has moved to a new section of the Guidelines, entitled Drug-Drug Interactions Between Ritonavir-Boosted Nirmatrelvir (Paxlovid) and Concomitant Medications. The Ritonavir-Boosted Nirmatrelvir (Paxlovid) section retains the general description of ritonavir-boosted nirmatrelvir, the Panel’s recommendations for using this regimen, and a discussion of the clinical data that support those recommendations. Downloaded from eatment Guidelines 7 This section has been updated to acknowledge reports of SARS-CoV-2 viral rebound and the recurrence of COVID-19 symptoms in patients who completed a 5-day course of ritonavir-boosted nirmatrelvir. The frequency and clinical implications of these events are not yet known. Drug-Drug Interactions Between Ritonavir-Boosted Nirmatrelvir (Paxlovid) and Concomitant Medications Many commonly used medications can be safely coadministered with ritonavir-boosted nirmatrelvir despite its drug-drug interaction potential. In some cases, however, drug-drug interactions with ritonavirboosted nirmatrelvir may lead to serious or life-threatening drug toxicities. This new section highlights the importance of evaluating a patient’s medication regimen for potential drug-drug interactions before prescribing ritonavir-boosted nirmatrelvir. However, because ritonavir-boosted nirmatrelvir is the only highly effective oral antiviral for the treatment of COVID-19, drug-drug interactions that can be safely managed should not preclude the use of this regimen. The section provides guidance on management strategies and a variety of resources that clinicians can use to identify potential interactions between ritonavir-boosted nirmatrelvir and concomitant medications. This section also includes 2 quick reference lists: • Box 1 lists examples of commonly prescribed medications that can be safely coadministered with ritonavir-boosted nirmatrelvir. • Box 2 lists medications with clinically significant interactions with ritonavir-boosted nirmatrelvir. The list is divided into categories of medications that: • Should not be coadministered with ritonavir-boosted nirmatrelvir; • Can be withheld temporarily, if clinically appropriate; • May be continued with dose adjustments, if clinically appropriate; or • May be continued while the patient is monitored for adverse effects. Prioritization of Anti-SARS-CoV-2 Therapies for the Treatment and Prevention of COVID-19 When There Are Logistical or Supply Constraints The Panel updated this section to highlight that this prioritization guidance should be used ONLY when logistical or supply constraints limit the availability of therapies. The Panel emphasizes that when there are no supply or logistical constraints, therapies for the prevention or treatment of SARS-CoV-2 infection can be prescribed for any eligible individual as recommended in these Guidelines. Downloaded from https://www.covid19treatmentguidelines.nih.gov/ on 7/6/2022 COVID-19 Treatment Guidelines 8 Guidelines Development Last Updated: April 29, 2022 The COVID-19 Treatment Guidelines were developed to provide clinicians with guidance on how to care for patients with COVID-19. Because clinical information about the optimal management of COVID-19 is evolving quickly, these Guidelines are updated frequently to reflect newly published data and other authoritative information. Panel Composition Members of the COVID-19 Treatment Guidelines Panel (the Panel) are appointed by the Panel co-chairs based on their clinical experience and expertise in patient management, translational and clinical science, and/or the development of treatment guidelines. Panel members include representatives from federal agencies, health care organizations, academic organizations, and professional societies. Federal agencies and professional societies represented on the Panel include: • American Association of Critical-Care Nurses • American Association for Respiratory Care • American College of Chest Physicians • American College of Clinical Pharmacy • American College of Emergency Physicians • American College of Obstetricians and Gynecologists • American Society of Hematology • American Thoracic Society • Biomedical Advanced Research and Development Authority • Centers for Disease Control and Prevention • Department of Defense • Department of Veterans Affairs • Food and Drug Administration • Infectious Diseases Society of America • National Institutes of Health • Pediatric Infectious Diseases Society • Society of Critical Care Medicine • Society of Infectious Diseases Pharmacists The inclusion of representatives from professional societies does not imply that their societies have endorsed all elements of these Guidelines. The names, affiliations, and financial disclosures of the Panel members and ex officio members, as well as members of the Guidelines support team, are provided in the Panel Roster and Financial Disclosure sections of the Guidelines.