Paxlovid Contraindications

Hypersensitivity to the active substances or to any of the excipients listed in Description.
Medicinal products listed as follows are a guide and not considered a comprehensive list of all possible medicinal products that are contraindicated with Nirmatrelvir+Ritonavir (Paxlovid).
Medicinal products that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions: Alpha₁-adrenoreceptor antagonist: alfuzosin.
Antianginal: ranolazine.
Antiarrhythmic: amiodarone, dronedarone, flecainide, propafenone, quinidine.
Antibiotics: fusidic acid.
Anticancer drugs: neratinib, venetoclax.
Anti-gout: colchicine.
Antihistamines: terfenadine.
Antipsychotics/neuroleptics: clozapine, lurasidone, pimozide, quetiapine.
Benign prostatic hyperplasia medicinal products: silodosin.
Cardiovascular medicinal products: eplerenone, ivabradine.
Ergot derivatives: dihydroergotamine, ergonovine, ergotamine, methylergonovine.
GI motility agents: cisapride.
Immunosuppressants: voclosporin.
Lipid-modifying agents: HMG Co-A reductase inhibitors: lovastatin, simvastatin; Microsomal triglyceride transfer protein (MTTP) inhibitor: lomitapide.
Migraine medicinal products: eletriptan.
PDE5 inhibitor: avanafil, sildenafil, tadalafil, vardenafil.
Sedative/hypnotics: clorazepate, diazepam, estazolam, flurazepam, oral midazolam and triazolam.
Vasopressin receptor antagonists: tolvaptan.
Medicinal products that are potent CYP3A inducers where significantly reduced nirmatrelvir/ritonavir plasma concentrations may be associated with the potential for loss of virologic response and possible resistance: Antibiotics: rifampicin.
Anticancer drugs: apalutamide.
Anticonvulsants: carbamazepine, phenobarbital, phenytoin.
Herbal products: St. John's wort (Hypericum perforatum).
Nirmatrelvir+Ritonavir (Paxlovid) cannot be started immediately after discontinuation of CYP3A4 inducers due to the delayed offset of the recently discontinued CYP3A4 inducer (see Interactions).
A multi-disciplinary approach (e.g., involving physicians and specialists in clinical pharmacology) should be considered to determine the adequate timing for Nirmatrelvir+Ritonavir (Paxlovid) initiation taking into account the delayed offset of the recently discontinued CYP3A inducer and the need to initiate Nirmatrelvir+Ritonavir (Paxlovid) within 5 days of symptom onset.