Crushing nirmatrelvir+ritonavir (Paxlovid®) tablets
- December 22, 2022
Pfizer state in their prescribing information that both nirmatrelvir and ritonavir tablets should be swallowed whole and not chewed, broken, or crushed.  This is due to a lack of pharmacokinetic data to support administration in this manner. However, a Phase 1 study with a nirmatrelvir suspension found similar pharmacokinetic parameters to those reported for the tablet.  Pfizer have also released information on how to prepare a liquid suspension from nirmatrelvir and ritonavir tablets for administration via enteral tubes, based on an unpublished laboratory study assessing the physiochemical stability of such a formulation. 
|Given that alternative antivirals may not be as effective as nirmatrelvir+ritonavir, we suggest it is reasonable to crush these tablets for those patients who have trouble swallowing, or who require administration via an enteral tube.|
|Enteral tubes||Trouble swallowing|
Data sheet: Paxlovid. [Internet]. Pfizer New Zealand Pty Ltd; [cited 2022 Dec 19]. Available from: https://www.medsafe.govt.nz/profs/Datasheet/p/paxlovidtab.pdf
2. Innovative Randomized Phase 1 Study and Dosing Regimen Selection to Accelerate and Inform Pivotal COVID-19 Trial of Nirmatrelvir | medRxiv [Internet]. [cited 2022 Dec 19]. Available from: https://www.medrxiv.org/content/10.1101/2022.02.08.22270649v1
3. Pfizer Medical Information. PF-07321332 (nirmatrelvir)/Ritonavir Administration via Enteral Feeding Tubes. 2022.