Stopping a Statin for Paxlovid: Choose This Safer Option Instead

• Paxlovid, a COVID-19 antiviral, contains ritonavir, which blocks a liver enzyme that metabolizes many drugs including certain statins.
• Blocking this pathway can cause some statins to build up, raising the risk of muscle pain.
• Lovastatin and simvastatin must be stopped, while atorvastatin or rosuvastatin are usually paused during Paxlovid therapy.
• Pitavastatin (Zypitamag) has minimal CYP3A4 metabolism, making it a safer option with lower risk of interactions while managing cholesterol.

When you're prescribed Paxlovid for COVID-19, your doctor might tell you to stop taking your statin temporarily. That’s because Paxlovid can interact with certain statins in ways that may cause serious side effects.

But not all statins are the same, and some may be safe to take during Paxlovid treatment.

What is Paxlovid?

Paxlovid is an oral antiviral treatment for COVID-19 and used to reduce the risk of severe illness and hospitalization in high-risk patients. The goal of this medication is to be taken within five days of symptom onset to stop the virus from replicating effectively.

The typical course is a 5-day regimen of two tablets taken twice a day. It is approved for use in adults and children 12 years and older who weigh at least 88 pounds and have symptoms that began within the last five days.

The Interaction Between Paxlovid and Statins

Paxlovid combines two drugs, nirmatrelvir and ritonavir:

• Nirmatrelvir blocks the virus from replicating
• Ritonavir boosts the levels of nirmatrelvir in the body

Paxlovid’s key booster, ritonavir, is what drives interactions. Ritonavir blocks an enzyme called CYP3A4, which is a major part of the liver’s “drug-clearing system.” CYP3A4 is responsible for breaking down around 60% of all drugs. This helps Paxlovid work better, but it also means other drugs that rely on the same enzyme can build up in the body.

When CYP3A4 is blocked by ritonavir, statins that depend on this pathway reach higher-than-normal levels, raising the risk of side effects, particularly muscle-related problems.

Managing Statin Use During Paxlovid Treatment

Because of this risk, managing statin use is critical. The recommended approach is to either temporarily stop or switch the statin.

• Lovastatin and simvastatin are heavily dependent on the CYP3A4 pathway and cannot be used with Paxlovid. Patients must stop taking them at least 12 hours before starting Paxlovid and should not restart until 5 days after their last dose.
• Atorvastatin and rosuvastatin also use the CYP3A4 pathway but can often be managed with a temporary hold during the 5-day Paxlovid course, as advised by your doctor.
• Pravastatin and pitavastatin (Zypitamag) are less dependent on CYP3A4, and therefore less likely to interact.

Compare pitavastatin and pravastatin.

Why Zypitamag is a Safer Choice

Zypitamag (pitavastatin) is metabolized differently from other statins. Instead of primarily using the CYP3A4 pathway, it's mainly broken down through a different process called glucuronidation. This means it bypasses the "blocked" CYP3A4 pathway and is processed through another one.

Because its metabolism isn't significantly affected by ritonavir, there's a much lower risk of drug accumulation and the associated muscle side effects.

Zypitamag is a moderate-intensity statin that lowers LDL cholesterol in adults.

• How it is metabolized: Pitavastatin is broken down mainly through glucuronidation, not through CYP3A4.
• Why this matters: Because Paxlovid blocks CYP3A4, statins that use this pathway can accumulate. Pitavastatin avoids CYP3A4, so the risk of interaction is much lower.
• Effectiveness: Research shows pitavastatin is as effective as atorvastatin 10–20 mg or simvastatin 20–40 mg at lowering LDL cholesterol, and more effective than pravastatin at common doses.

The bottom line

• Paxlovid is a vital treatment for COVID-19 in high-risk patients, but it interacts with many medications, including some statins.
• Instead of avoiding Paxlovid, doctors can manage statins by pausing them temporarily or switching to alternatives like pitavastatin.
• Zypitamag offers a lower-risk statin option during treatment because its metabolism bypasses the main pathway affected by Paxlovid.

Always review your full medication list with your healthcare provider if Paxlovid is prescribed. This ensures you get the COVID-19 treatment you need while safely managing other conditions.