Should Heart Patients Stop Medications When Taking Pfizer Paxlovid?

Should patients with myocardial infarction discontinue their cardiac medications while taking Pfizer's Paxlovid?

Hello, doctor.
My father had a myocardial infarction 10 years ago and received one drug-eluting stent, followed by another drug-eluting stent a year and a half ago.
He has been regularly visiting the clinic, and his health status is normal with no issues related to hypertension, diabetes, or hyperlipidemia.
He has not received the COVID-19 vaccine and regularly takes Bokey and Lipitor.
Today, after testing positive for COVID-19, the clinic physician prescribed Pfizer's Paxlovid oral antiviral medication and mentioned that he could continue taking his heart medications.
However, the pharmacist advised stopping them for 8 days, which has caused confusion.
Should he stop taking Bokey and Lipitor? If so, for how many days? Thank you very much.

Niming, 20~29 year old female. Ask Date: 2022/12/01

Dr. Wu Xueming reply Cardiology

No need to discontinue.

Reply Date: 2022/12/01

More Info

When it comes to heart patients taking Pfizer's Paxlovid, the general consensus among healthcare professionals is that it is not necessary to stop heart medications such as Bokey (a brand name for bisoprolol) and Lipitor (atorvastatin) while undergoing treatment with Paxlovid. The confusion often arises from the potential interactions between Paxlovid and other medications, but in this case, both Bokey and Lipitor are typically safe to continue.

Paxlovid is an antiviral medication used to treat COVID-19, and it consists of two active ingredients: nirmatrelvir and ritonavir. Ritonavir is known to interact with a variety of medications due to its effect on liver enzymes that metabolize drugs. However, both bisoprolol and atorvastatin are not significantly affected by ritonavir in a way that would necessitate stopping them.
Bokey (bisoprolol) is a beta-blocker commonly prescribed for managing hypertension and heart conditions. It works by slowing down the heart rate and reducing the workload on the heart. Lipitor (atorvastatin) is a statin used to lower cholesterol levels and reduce the risk of cardiovascular disease. Both medications are crucial for maintaining heart health, especially in patients with a history of myocardial infarction and stent placement.

The advice from the prescribing physician to continue these medications is appropriate, as stopping them could lead to adverse effects such as increased heart rate, elevated blood pressure, or worsening cholesterol levels. On the other hand, the pharmacist's recommendation to stop these medications for eight days may stem from a cautious approach to drug interactions, but it is not aligned with the current understanding of their safety in conjunction with Paxlovid.

It is essential for patients to communicate openly with their healthcare providers about any concerns regarding medication interactions. If there are doubts or if the patient experiences any unusual symptoms while taking Paxlovid alongside their heart medications, they should consult their physician for further evaluation.
In summary, heart patients like your father, who are on medications such as Bokey and Lipitor, do not need to stop these medications when starting Paxlovid. It is vital to maintain the prescribed heart medications to ensure ongoing cardiovascular stability and health. If there are any changes in symptoms or concerns about medication interactions, a follow-up with the healthcare provider is always recommended for personalized medical advice.

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