Posterior Reversible Encephalopathy Syndrome in an Older Patient in the COVID-19 and Paxlovid Era
Nirmatrelvir/ritonavir (Paxlovid) has been prescribed increasingly for treatment of COVID-19. Due to ritonavir's inhibition of CYP3A4, there are many medication interactions to consider. In this case, a 63-year-old woman recently treated with Paxlovid presented with symptoms mimicking previous...
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| Format: | Article |
| Language: | English |
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American College of Physicians
2023-12-01
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| Series: | Annals of Internal Medicine: Clinical Cases |
| Online Access: | https://www.acpjournals.org/doi/10.7326/aimcc.2023.0872 |
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| author | Katharine Rosiene Minisha Lohani Mario Gemmato-Valecillos Cristina Marti-Amarista Sadia Abbasi |
| author_facet | Katharine Rosiene Minisha Lohani Mario Gemmato-Valecillos Cristina Marti-Amarista Sadia Abbasi |
| author_sort | Katharine Rosiene |
| collection | DOAJ |
| description | Nirmatrelvir/ritonavir (Paxlovid) has been prescribed increasingly for treatment of COVID-19. Due to ritonavir's inhibition of CYP3A4, there are many medication interactions to consider. In this case, a 63-year-old woman recently treated with Paxlovid presented with symptoms mimicking previous episodes of lupus cerebritis. Imaging, however, revealed a pattern more consistent with posterior reversible encephalopathy syndrome. When Paxlovid therapy was initiated in the ambulatory setting, her amlodipine dose was decreased due to concern for interactions. Since Paxlovid is recommended for patients with high risk for progression to severe illness, this poses a unique challenge, especially in older patients with multiple comorbid conditions. |
| format | Article |
| id | doaj-art-47b3a39b75084f0a9242f63cddd71ff1 |
| institution | OA Journals |
| issn | 2767-7664 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | American College of Physicians |
| record_format | Article |
| series | Annals of Internal Medicine: Clinical Cases |
| spelling | doaj-art-47b3a39b75084f0a9242f63cddd71ff12025-08-20T02:27:23ZengAmerican College of PhysiciansAnnals of Internal Medicine: Clinical Cases2767-76642023-12-0121210.7326/aimcc.2023.0872Posterior Reversible Encephalopathy Syndrome in an Older Patient in the COVID-19 and Paxlovid EraKatharine Rosiene0Minisha Lohani1Mario Gemmato-Valecillos2Cristina Marti-Amarista3Sadia Abbasi41Stony Brook University Hospital, Stony Brook, New York1Stony Brook University Hospital, Stony Brook, New York2Catedra Rectoral de Medicina Basada en la Evidencia, Universidad de Carabobo, Valencia, Venezuela1Stony Brook University Hospital, Stony Brook, New York1Stony Brook University Hospital, Stony Brook, New YorkNirmatrelvir/ritonavir (Paxlovid) has been prescribed increasingly for treatment of COVID-19. Due to ritonavir's inhibition of CYP3A4, there are many medication interactions to consider. In this case, a 63-year-old woman recently treated with Paxlovid presented with symptoms mimicking previous episodes of lupus cerebritis. Imaging, however, revealed a pattern more consistent with posterior reversible encephalopathy syndrome. When Paxlovid therapy was initiated in the ambulatory setting, her amlodipine dose was decreased due to concern for interactions. Since Paxlovid is recommended for patients with high risk for progression to severe illness, this poses a unique challenge, especially in older patients with multiple comorbid conditions.https://www.acpjournals.org/doi/10.7326/aimcc.2023.0872 |
| spellingShingle | Katharine Rosiene Minisha Lohani Mario Gemmato-Valecillos Cristina Marti-Amarista Sadia Abbasi Posterior Reversible Encephalopathy Syndrome in an Older Patient in the COVID-19 and Paxlovid Era Annals of Internal Medicine: Clinical Cases |
| title | Posterior Reversible Encephalopathy Syndrome in an Older Patient in the COVID-19 and Paxlovid Era |
| title_full | Posterior Reversible Encephalopathy Syndrome in an Older Patient in the COVID-19 and Paxlovid Era |
| title_fullStr | Posterior Reversible Encephalopathy Syndrome in an Older Patient in the COVID-19 and Paxlovid Era |
| title_full_unstemmed | Posterior Reversible Encephalopathy Syndrome in an Older Patient in the COVID-19 and Paxlovid Era |
| title_short | Posterior Reversible Encephalopathy Syndrome in an Older Patient in the COVID-19 and Paxlovid Era |
| title_sort | posterior reversible encephalopathy syndrome in an older patient in the covid 19 and paxlovid era |
| url | https://www.acpjournals.org/doi/10.7326/aimcc.2023.0872 |
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