BRIEF RESEARCH REPORT article
Front. Pharmacol.
Sec. Drug Metabolism and Transport
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1654671
This article is part of the Research TopicAdvancements and Strategies in Predicting and Managing Clinical Drug-Drug InteractionsView all 4 articles
Plasma concentration of voriconazole under concomitant use of nirmatrelvir/ritonavir in patients with COVID-19: a multicenter retrospective study
Provisionally accepted
- 1Department of Pharmacy, Sir Run Run Shaw Hospital, Hangzhou, China
- 2Northern Jiangsu People's Hospital, Yangzhou, China
- 3The Second Affiliated Hospital of Zhejiang University School of Medicine Oncology Institute, Hangzhou, China
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Background: The concomitant use of nirmatrelvir/ritonavir and voriconazole is generally contraindicated in clinical practice because of drug-drug interactions (DDIs).However, emerging clinical data suggest that this DDI is complicated and that the concomitant use of these two drugs may be feasible.Methods: This was a multicenter retrospective study. Hospitalized patients who were diagnosed with COVID-19 in 2023 and who received concomitant nirmatrelvirritonavir and voriconazole were retrospectively included according to preset criteria.Personal information, medication records and voriconazole plasma levels were obtained from the hospital information system. The voriconazole concentrations were analyzed.Results: A total of 13 hospitalized patients with COVID-19 and 16 voriconazole trough concentrations were included from 4 centers. Half of the patients (8 patients, 50.0%) had voriconazole plasma concentrations within the therapeutic range. The remaining 8 cases (50.0%) fell outside the therapeutic range, including 1 case (12.5%) with subtherapeutic levels and 7 cases (87.5%) with supratherapeutic concentrations.The concomitant use of nirmatrelvir/ritonavir and voriconazole might be feasible, but the dosing of voriconazole needs further study.
Keywords: nirmatrelvir/ritonavir, Voriconazole, Drug Interaction, Therapeutic drug monitoring, CYP = cytochrome P450
Received: 26 Jun 2025; Accepted: 31 Jul 2025.
Copyright: © 2025 Shi, Zhang, Kong, Yu and Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Lingyan Yu, The Second Affiliated Hospital of Zhejiang University School of Medicine Oncology Institute, Hangzhou, China
Zhenwei Yu, Department of Pharmacy, Sir Run Run Shaw Hospital, Hangzhou, China
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