Assessing the use of nirmatrelvir/ritonavir and considerations regarding its drug interactions in COVID-19 positive patients at an adult inpatient state psychiatric facility

Introduction: Patients with mental illness have a high risk of COVID-19 progression into severe illness, which makes them a candidate for nirmatrelvir/ritonavir therapy. However, certain psychiatric medications are contraindicated with nirmatrelvir/ritonavir. Between January 6th and January 24th, 2022, five patients at an inpatient state psychiatric facility were prescribed nirmatrelvir/ritonavir. Two patients had psychiatric drug interactions with nirmatrelvir/ritonavir that required alteration to their psychiatric medication regimen. One patient's divalproex and haloperidol doses were decreased, and the patient was able to complete their course of nirmatrelvir/ritonavir therapy, then resume their psychiatric medications at their usual doses. Another patient's lurasidone was discontinued and their long-acting injection dosing was decreased. This patient refused to take nirmatrelvir/ritonavir therapy, became more psychotic and delusional, and began refusing all medications. Her nirmatrelvir/ritonavir was discontinued without the patient completing the course and the patient continued to experience paranoia, delusions, and hallucinations. No patients were hospitalized for COVID-19. Although nirmatrelvir/ritonavir is highly effective at reducing COVID-19 hospitalizations and death, it is unclear as to its use for psychiatric patients who have psychotropic drug interactions who have the possibility of decompensating if their psychiatric medication regimen is altered.