Benign prostatic enlargement with treated voiding LUTS — MSRA MCQ
Instant feedback + full explanation. One question, done properly.
Educational content. Not a substitute for clinical judgement or local policy.
Reveal the answer and explanation
Correct answer: D — Do not prescribe nirmatrelvir/ritonavir and arrange assessment for an alternative COVID-19 treatment
Alfuzosin is contraindicated with nirmatrelvir/ritonavir (Paxlovid). Ritonavir is a potent CYP3A4 inhibitor and can substantially increase alfuzosin exposure, risking severe hypotension. Therefore, nirmatrelvir/ritonavir should not be prescribed; the COVID medicines service should consider an alternative appropriate treatment. Temporarily stopping alfuzosin may initially appear attractive because alfuzosin is not required to treat an immediately life-threatening condition. However, the Paxlovid SmPC specifies concomitant alfuzosin as a contraindication rather than providing a withholding-and-restarting strategy. In addition, alfuzosin interruption could precipitate recurrent troublesome obstruction or retention. Dose reduction of Paxlovid does not address the interaction, because the mechanism is ritonavir-mediated inhibition of alfuzosin metabolism. Switching to tamsulosin is also inappropriate: tamsulosin exposure can rise with strong CYP3A4 inhibitors and its SmPC advises caution with ritonavir. Monitoring blood pressure does not make a formally contraindicated combination acceptable, since severe hypotension may occur unpredictably.
Reference: Paxlovid 150 mg/100 mg film-coated tablets - Summary of Product Characteristics (Updated 2026) — https://www.medicines.org.uk/emc/product/13145/smpc Tamsulosin hydrochloride SUN Pharma 400 micrograms prolonged-release hard capsules - Summary of Product Characteristics (Updated 2025) — https://www.medicines.org.uk/emc/product/2508/smpc NICE CG97: Lower urinary tract symptoms in men: management - Drug treatment (Last reviewed December 2024) — https://www.nice.org.uk/guidance/cg97/chapter/recommendations