Nirmatrelvir/ritonavir was recently granted emergency use authorization for mild-moderate coronavirus disease 2019. Drug-drug interactions between ritonavir and tacrolimus are under-appreciated by non-transplant providers. We describe two solid organ transplant recipients prescribed nirmatrelvir/ritonavir for outpatient use that developed tacrolimus toxicity requiring hospitalization and were managed with rifampin for toxicity reversal.
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