Paxlovid-Induced Tacrolimus Toxicity in the Treatment of COVID-19: A Case Report

Stephanie Michael; Rachel Heilbronner; Christopher M Lloyd; Howard W Levitin

doi:10.7759/cureus.35489

Paxlovid-Induced Tacrolimus Toxicity in the Treatment of COVID-19: A Case Report

Cureus. 2023 Feb 26;15(2):e35489. doi: 10.7759/cureus.35489. eCollection 2023 Feb.

Authors

Stephanie Michael¹, Rachel Heilbronner², Christopher M Lloyd¹, Howard W Levitin¹

Affiliations

¹ Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA.
² Pharmacology and Therapeutics, OhioHealth Doctors Hospital, Columbus, USA.

Abstract

Paxlovid^TM (nirmaltrelvir/ritonavir) received emergency use authorization from the Food and Drug Administration (FDA) in December 2021 to treat coronavirus disease 2019 (COVID-19). Given the actions of Paxlovid on cytochrome P450-3A4 (CYP3A4) enzymes, it is imperative to check for potential drug-drug interactions before prescribing. We describe a case in which the common emergency department presentation of generalized weakness was found to be caused by interactions between Paxlovid and a patient's home medications resulting in tacrolimus toxicity.

Keywords: covid-19; drug-drug interactions; geriatrics and internal medicine; pandemic emergency medicine; paxlovid.

Publication types

Case Reports