Supratherapeutic Tacrolimus Concentrations With Nirmatrelvir/Ritonavir in Solid Organ Transplant Recipients Requiring Hospitalization: A Case Series Using Rifampin for Reversal

Open Forum Infect Dis. 2022 May 13;9(7):ofac238. doi: 10.1093/ofid/ofac238. eCollection 2022 Jul.


Nirmatrelvir/ritonavir was recently granted emergency use authorization for mild to moderate coronavirus disease 2019. Drug-drug interactions between ritonavir and tacrolimus are underappreciated by nontransplant providers. We describe 2 solid organ transplant recipients prescribed nirmatrelvir/ritonavir for outpatient use who developed tacrolimus toxicity requiring hospitalization and were managed with rifampin for toxicity reversal.

Keywords: COVID-19; drug interactions; nirmatrelvir/ritonavir; tacrolimus.

Publication types

  • Case Reports