# A client who takes simvastatin is prescribed a 5-day course of nirmatrelvir with ritonavir. Which action should the nurse take?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=516672&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client who takes simvastatin is prescribed a 5-day course of nirmatrelvir with ritonavir. Which action should the nurse take?

## Option

1. Administer simvastatin throughout the 5-day antiviral course and monitor only the client temperature for evidence of interaction.
2. Hold simvastatin under the authorized plan from at least 12 hours before PAXLOVID until 5 days after the 5-day course ends. **✔ Correct answer**
3. Double the simvastatin dose while ritonavir is used because the antiviral lowers statin exposure and muscle-toxicity risk.
4. Cancel the antiviral regimen permanently and continue simvastatin without asking the prescriber or pharmacist about interaction management.

**Correct answer: 2**

## Explanation

Ritonavir markedly increases simvastatin exposure and myopathy or rhabdomyolysis risk. The current FDA label permits the antiviral regimen when simvastatin is temporarily discontinued for the specified interval.

## In-depth explanation

Quick answer
Prevent a dangerous interaction by holding simvastatin across the antiviral window.

Why this is correct
The FDA label states that coadministration is contraindicated and specifies stopping simvastatin at least 12 hours before treatment, during all 5 days, and for 5 days afterward when PAXLOVID is medically necessary.

Easy analogy or mental picture
Ritonavir closes the statin exit lane, so pause the statin until the traffic clears.

Memory hook
Simvastatin: 12 hours before, 5 days during, 5 days after.

NCLEX decision rule
Perform a complete interaction review because ritonavir affects many prescription, nonprescription, and herbal products.

Why the other choices are wrong
Coadministration and dose escalation increase toxicity; abandoning indicated antiviral treatment without an interaction plan is also inappropriate.References
1FDA: PAXLOVID Prescribing InformationContraindicated simvastatin coadministration and required temporary discontinuation interval

## Clinical scenario

Ritonavir interaction screen
Reconcile all medications, verify renal function and antiviral dose, document hold and restart dates, and teach muscle-toxicity warning symptoms.

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