Pharmacokinetics of Nirmatrelvir and Ritonavir in COVID-19 Patients with End-Stage Renal Disease on Intermittent Hemodialysis

Antimicrob Agents Chemother. 2022 Nov 15;66(11):e0122922. doi: 10.1128/aac.01229-22. Epub 2022 Oct 26.


Nirmatrelvir/ritonavir is an effective antiviral therapy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Use is not recommended in patients with end-stage renal disease (ESDR) due to a lack of data. We investigated the pharmacokinetics of nirmatrelvir/ritonavir (150 mg/100 mg twice a day) in four patients with ESRD undergoing hemodialysis. Nirmatrelvir peak concentrations ranged from 4,563 to 7,898 ng/mL and declined after hemodialysis. Concentrations were up to 4-fold higher but still within the range known from patients without ESRD, without accumulation of nirmatrelvir after the end of treatment.

Keywords: COVID-19; Paxlovid; end-stage renal disease; hemodialysis; nirmatrelvir/ritonavir.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents / therapeutic use
  • COVID-19 Drug Treatment*
  • Humans
  • Kidney Failure, Chronic* / drug therapy
  • Renal Dialysis
  • Ritonavir / therapeutic use
  • SARS-CoV-2


  • Ritonavir
  • Antiviral Agents