500mg single dose by IV infusion over 30 minutes
No dose alteration is required for renal or hepatic impairment although the drug has not been studied in patients with severe renal or hepatic impairment. Please see appendix 3 for a clinical worksheet detailing the preparation and administration information. Patients should be monitored for 30 minutes after the infusion is complete. The patient should be given the paper information leaflet supplied with the drug (appendix 4). Administration should be under taken in areas where management of severe hypersensitivity reactions, such as anaphylaxis, is possible.
PF-07321332 (nirmatrelvir) plus ritonavir (Paxlovid®):
300mg (two x 150mg tablets) PF-07321332 (nirmatrelvir) PLUS 100mg (one x 100mg tablet) ritonavir taken together orally twice daily for 5 days
In moderate renal impairment (eGFR between 30 and 60 mL/min), dose is 150mg (one x 150mg tablets) PF-07321332 (nirmatrelvir) PLUS 100mg (one x 100mg tablet) ritonavir taken together orally twice daily for 5 days. If a reduced dose is required, the dispenser should remove the extra PF-07321332 tablets from the blister to ensure the correct dose will be taken and explain the alteration to the patient. An additional information leaflet should be given to the patient to explain the reduced dose (appendix 5). Clinicians should assure themselves that patients are able to swallow the oral tablets and understand the dosing regimen. A patient information leaflet from the manufacturer is included with the medicines supplied.
A missed dose should be taken as soon as possible and within 8 hours of the scheduled time, and the normal dosing schedule should be resumed. If more than 8 hours has elapsed, the missed dose should not be taken and the treatment should resume according to the normal dosing schedule.
If a patient requires hospitalisation due to severe or critical COVID-19 after starting treatment with PF-07321332 (nirmatrelvir) plus ritonavir(Paxlovid®), the patient should complete the full 5-day treatment course at the discretion of the admitting consultant.
200mg by IV infusion on day 1 followed by 100mg by IV infusion on days 2 and 3
Each dose should be diluted in either a 250ml (200mg dose) or 100ml (100mg dose) pre-filled bag of 0.9% sodium chloride solution and infused over a minimum of 30 minutes. The dose should be given at the same time each day.
800mg (four x 200mg capsules) orally twice a day for 5 days
No dose alteration is required in renal or hepatic impairment. The treatment course is supplied as 200mg hard capsules which are each 22mm in length and should be swallowed whole with a glass of water and not crushed, chewed or opened. There is no alternative formulation for patients with swallowing difficulties. Patients should complete the whole course of treatment to reduce the possibility of emerging resistance, even if their symptoms improve. Advice for missed doses:
- It is important that patients do not miss or skip doses of this medicine.
- If the patient forgets to take a dose within 10 hours of the time it is usually taken, they should take it as soon as possible and take the next one at the usual time.
- If the patient forgets to take a dose by more than 10 hours, they should not take the missed dose and instead take the next one at the usual time.
- Do not take a double dose to make up for a missed dose.
The patient should be directed to read the manufacturer’s patient information leaflet provided with the medicines AND given a copy of the MHRA leaflet highlighting the information in relation to pregnancy (appendix 6).
If a patient requires hospitalisation due to severe or critical COVID-19 after starting treatment with molnupiravir, the patient should complete the full 5-day treatment course at the discretion of the admitting consultant.