Paxlovid包含了兩個藥物-nirmatrelvir和ritonavir。 Nirmatrelivir是可以抑制SARS-CoV-2 Mproenzyme的活動， Nirmatrelvir係用于代謝嘅細胞色素P450 CYP3A4嘅底物（substrate）。
Ritonavir是一種HIV藥物，可抑制CYP3A4並減緩Nirmatrelvir的代謝，從而增強Nirmatrelvir的抗病毒活性的功效。
但很多藥物都是和CYP3A4有關的，所以，用Paxlovid時，同時服用某些藥物是有風險的。
另一方面，它也可能觸發肝病，也可能提高對HIV蛋白酶抑製劑產生抵抗性的風險。 需要先和醫生討論才服用此藥物，如果治療成功，是可以讓我們回復正常生活。
以下是FDA对服用者的提示：
Do not take PAXLOVID if:
• You are allergic to nirmatrelvir, ritonavir, or any of the ingredients in PAXLOVID.
病人對nirmatrelvir, ritonavir或PAXLOVID中的任何成分過敏。
• You are taking any of the following medicines:
病人正在服用以下任何藥物
o Alfuzosin
o Pethidine, propoxyphene
o Ranolazine
o Amiodarone, dronedarone, flecainide, propafenone, quinidine
o Colchicine
o Lurasidone, pimozide, clozapine
o Dihydroergotamine, ergotamine, methylergonovine
o Lovastatin, simvastatin
o Sildenafil (Revatio®) for pulmonary arterial hypertension (PAH)
o Triazolam, oral midazolam
o Apalutamide
o Carbamazepine, phenobarbital, phenytoin
o Rifampin
o St. John’s Wort (hypericum perforatum)
Taking PAXLOVID with these medicines may cause serious or life-threatening side
effects or affect how PAXLOVID works
These are not the only medicines that may cause serious side effects if taken with
PAXLOVID.
PAXLOVID may increase or decrease the levels of multiple other
medicines.
與這些藥物一起服用 PAXLOVID 可能會導致嚴重或危及生命的副作用或影響 PAXLOVID 的效力和方式
如果與 PAXLOVID 一起服用，這些並不是唯一可能導致嚴重副作用的藥物。
PAXLOVID 可能會增加或減少多種其他藥物的水平。
Possible side effects of PAXLOVID are:
PAXLOVID嘅可能副作用係：
• Allergic Reactions. 過敏反應 Allergic reactions can happen in people taking
PAXLOVID, even after only 1 dose.
Stop taking PAXLOVID and call your
healthcare provider right away if you get any of the following symptoms of an
allergic reaction:
停止服用PAXLOVID，如果您出現以下任何過敏反應症狀，請立即致電您的醫療保健提供者：
o hives 麻疹
o trouble swallowing or breathing 吞嚥或呼吸困難
o swelling of the mouth, lips, or face 口腔、嘴唇或面部腫脹
o throat tightness 喉嚨發緊
o hoarseness
聲音嘶啞
o skin rash 皮疹
• Liver Problems. 肝臟問題。 Tell your healthcare provider right away if you have any of
these signs and symptoms of liver problems: loss of appetite, yellowing of your
skin and the whites of eyes (jaundice), dark-colored urine, pale colored stools
and itchy skin, stomach area (abdominal) pain.
• Resistance to HIV Medicines. If you have untreated HIV infection, PAXLOVID
may lead to some HIV medicines not working as well in the future.
·對愛滋病毒藥物的耐藥性。 如果病人有未經治療的HIV感染，PAXLOVID可能會導致一些HIV藥物在未來不起作用。
• Other possible side effects include:
o altered sense of taste
o diarrhea
o high blood pressure
o muscle aches
·其他可能嘅副作用包括：
o味覺改變
o腹瀉
o高血壓
o肌肉痠痛
These are not all the possible side effects of PAXLOVID.
Not many people have taken
PAXLOVID. Serious and unexpected side effects may happen. PAXLOVID is still being
studied, so it is possible that all of the risks are not known at this time
冇幾多人服用過PAXLOVID。 可能會發生嚴重和意想不到的副作用。 PAXLOVID仍在研究中，因此目前可能尚不清楚所有風險 。
https://www.fda.gov/media/155051/download
Reference
1. Heather Eng et al, Drug Metab Dispos. 2022 Feb 13.
2. Drug product insert。
