Drug interactions
Eplerenone + Nirmatrelvir / ritonavir
Severity: Contraindicated
Eplerenone and Nirmatrelvir / ritonavir: contraindicated interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Ritonavir in this combination strongly inhibits CYP3A4, greatly increasing eplerenone exposure and the risk of severe hyperkalemia. Eplerenone is contraindicated with strong CYP3A4 inhibitors.
What this interaction means in plain words
Eplerenone and Nirmatrelvir / ritonavir are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Why it happens
Strong ritonavir-mediated CYP3A4 inhibition reduces eplerenone metabolism.
What to do
Withhold eplerenone during the antiviral course and for a few days afterward as advised by current labeling, and check potassium and renal function if exposure occurs.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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References
Other interactions of Eplerenone
- Amiloride + Eplerenone Contraindicated
- Atazanavir + Eplerenone Contraindicated
- Clarithromycin + Eplerenone Contraindicated
- Cobicistat + Eplerenone Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Eplerenone Contraindicated
- Ensitrelvir + Eplerenone Contraindicated
Frequently asked questions
Can I take Eplerenone with Nirmatrelvir / ritonavir?
MediHelp rates the interaction as contraindicated. Eplerenone and Nirmatrelvir / ritonavir are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. Ritonavir in this combination strongly inhibits CYP3A4, greatly increasing eplerenone exposure and the risk of severe hyperkalemia. Eplerenone is contraindicated with strong CYP3A4 inhibitors.
How serious is the interaction between Eplerenone and Nirmatrelvir / ritonavir?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Withhold eplerenone during the antiviral course and for a few days afterward as advised by current labeling, and check potassium and renal function if exposure occurs.
What other medicines interact with Eplerenone?
MediHelp also lists interactions of Eplerenone with, for example, Amiloride, Atazanavir, Clarithromycin. The full list is on the Eplerenone page.
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