Diclofenac apixaban — GPhC CRA MCQ
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Correct answer: B — Do not co-administer; urgently agree a temporary lipid-lowering plan because ritonavir makes simvastatin contraindicated
Option B is correct: ritonavir strongly inhibits CYP3A4 and can markedly raise simvastatin concentrations, causing myopathy or rhabdomyolysis; the combination is contraindicated and the prescriber should agree an interruption or alternative plan. Option D cannot remove persistent inhibition by spacing. Option A does not make simvastatin safe. Option C delays action until after exposure. Option E substitutes another contraindicated CYP3A-dependent statin.
Reference: Paxlovid SmPC: https://www.gov.uk/government/publications/regulatory-approval-of-paxlovid/summary-of-product-characteristics-for-paxlovid