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Nirmatrelvir/Ritonavir (Paxlovid®)

Selected References:

  • American College of Obstetricians and Gynecologists (ACOG). 2020 (with ongoing updates). COVID-19 FAQs for obstetrician-gynecologists, obstetrics. Available at https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-obstetrics. Retrieved May 19, 2024.
  • Anderson PO. 2022. COVID-19 drugs and breastfeeding update. Breastfeed Med. 17:377–9.
  • Chourasia P, et al. 2023. Paxlovid (nirmatrelvir and ritonavir) use in pregnant and lactating woman: Current evidence and practice guidelines-a scoping review. Vaccines (Basel). 11:107.
  • Chuang MT, et al. 2024. Transplacental passage of nirmatrelvir in pregnant women with COVID-19. Int J Gynaecol Obstet. 164(1):351-353.
  • Corbett AH, Kayira D, White NR, et al. Antiretroviral pharmacokinetics in mothers and breastfeeding infants from 6 to 24 weeks post-partum: Results of the BAN Study. Antivir Ther. 2014;19:587–95.
  • Gandhi M, et al. 2013. Hair and plasma data show that lopinavir, ritonavir, and efavirenz all transfer from mother to infant in utero, but only efavirenz transfers via breastfeeding. J Acquir Immune Defic Syndr. 63:578–84.
  • Garneau WM, et al. 2022. Analysis of clinical outcomes of pregnant patients treated with nirmatrelvir and ritonavir for acute SARS-CoV-2 infection. JAMA Netw Open. 5(11):e2244141.
  • Lin CY, et al. 2023. Nirmatrelvir-ritonavir (Paxlovid) for mild coronavirus disease 2019 (COVID-19) in pregnancy and lactation. Obstet Gynecol. 141:957–60.
  • Lin CW, et al. 2023. Clinical outcomes of nirmatrelvir-ritonavir use in pregnant women during the Omicron wave of the coronavirus disease 2019 pandemic. J Infect Public Health. 16(12):1942-1946.
  • Loza A, et al. 2022. Short-term pregnancy outcomes after nirmatrelvir-ritonavir treatment for mild-to-moderate coronavirus disease 2019 (COVID-19). Obstet Gynecol. 140(3):447-449.
  • Palombi L, et al. 2012. Antiretroviral prophylaxis for breastfeeding transmission in Malawi: drug concentrations, virological efficacy and safety. Antivir Ther. 17:1511–9.
  • Pfizer Laboratories Div Pfizer Inc. Last updated October 18, 2023. Paxlovid drug label. Source: National Library of Medicine. Available at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8a99d6d6-fd9e-45bb-b1bf-48c7f761232a.
  • Ramírez-Ramírez A, et al. 2018. Simultaneous quantification of four antiretroviral drugs in breast milk samples from HIV-positive women by an ultra-high performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method. PLoS One. 13:e0191236.
  • Rezk NL, et al. 2008. Studies on antiretroviral drug concentrations in breast milk: Validation of a liquid chromatography-tandem mass spectrometric method for the determination of 7 anti-human immunodeficiency virus medications. Ther Drug Monit. 30:611–9.

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