Detailed recommendations for interactions with experimental COVID-19 therapies

  • Heather Mason
  • Medical News
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The Liverpool Drug Interaction Group UK, University Hospital of Basel and Radboud UMC Netherlands have produced various materials to aid the use of experimental agents in the treatment of COVID-19.

Details of the nature of drug interactions with experimental COVID-19 therapies (atazanavir, lopinavir/ritonavir, and others) and many comedication classes are provided. A summary is provided for the use of comedications in HIV patients diagnosed with COVID-19.

Atazanavir (ATV) and lopinavir/ritonavir (LPV/r) are not intended to be combined for the treatment of COVID-19.

Important contraindication information is stated that dextropropoxyphene, and most antiarrhythmics, should not be coadministered with either ATV or LPR/r. The European product label for LPV/r contraindicates coadministration of amiodarone and LPV/r.

Coadministration of antipsychotic drug quetiapine and LPV/r is contraindicated in the European product label.

LPV/r may potentially decrease the analgesic effect of codeine and tramadol. Diamorphine and morphine coadministered with ATV or LPV/r could potentiate the opiate effect in the CNS. The daily dose of paracetamol should be reduced to no more than 3000 mg/day in adults.

The advice lists the coadministration of antibacterials and in particular, those which are expected to have no interaction with COVID-19 therapies. The dose of clarithromycin should be reduced when in combination with ATV or LPV/r, in patients with impaired renal function. The coadministration of delamanid with ATV or LPV/r may prolong QT intervals.

Doses of antidiabetic drugs canagliflozin may have to be increased when coadministered with LPV/r. The active metabolites of certain anti-hypertensive medications may be increased or decreased when coadministered with ATV or LPV/r.  

In cases of patients with swallowing difficulties, the crushing of tablets, or opening of capsules is not recommended. Oral solutions of both ATV and LPV/r are available and may be used with silicone or PVC feeding tubes. Antacids can reduce the absorption of ATV and should be taken at least 2 hours prior. Caution is advised with high doses of loperamide as patients may be at increased risk of cardiac events.

A full list of recommendations is available here.