Paxlovid and Alcohol: Food Interactions

Adjust the time between doses: Taking ritonavir with food may have a small effect on how well the drug works in the body. When the oral solution was given when the person wasn’t fasting, peak ritonavir concentrations were 23% lower and the amount absorbed was 7% lower than when the person was fasting. The amount and speed of ritonavir absorption did not change much when the oral solution was diluted with 240 mL of chocolate milk or a nutritional supplement (Advera or Ensure) one hour after the dose. When a single 100-mg dose of the tablet was given with a high-fat meal (907 kcal; 52% fat, 15% protein, and 33% carbohydrates), the mean peak concentration (Cmax) and systemic exposure (AUC) dropped by about 20% compared to when the tablet was given while the person was fasting. When the tablet was given with a moderate-fat meal, both Cmax and AUC went down by about the same amount. In contrast, the soft gelatin capsule form of ritonavir was absorbed 13% better when taken with a meal (615 kcal; 14.5% fat, 9% protein, and 76% carbohydrate) than when taken on an empty stomach.

Ritonavir should be taken with food to make it easier on the digestive system.

A significant amount of cholesterol (Hyperlipoproteinemia, Hypertriglyceridemia, Sitosterolemia)

Moderate chance of danger; high likelihood

PI: hyperlipidemia

During clinical trials, 10% of people who took ritonavir were found to have hyperlipidemia. Total cholesterol has been shown to go up by 30% to 40% from where it started, and triglycerides have gone up by 200% to 300% or more. During post-marketing use, these effects have also been seen with other protease inhibitors (PIs), but they may be the most noticeable with ritonavir. It is not clear what these increases mean for patients. It is known that pancreatitis can sometimes be caused by severe hyperlipidemia. Also, after starting PI treatment, some patients have been said to have developed symptoms of atherosclerosis and coronary artery disease. Patients who already have hyperlipidemia may need to be watched more closely during PI therapy and have their lipid-lowering plan changed as needed. People with coronary artery disease or a history of ischemic heart disease should be given PI therapy with care.

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