{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:57:59Z","timestamp":1773709079756,"version":"3.50.1"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100021671","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100021671","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["75N91019D00024"],"award-info":[{"award-number":["75N91019D00024"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In December 2021 and January 2022, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antiviral drug, nirmatrelvir\/ritonavir, was authorized in the United States, Canada, and Europe. However, ritonavir has significant drug-drug interaction (DDI) potential, and information resources were incomplete or provided conflicting advice for certain DDIs. Within the challenging pandemic setting, nirmatrelvir\/ritonavir was being prescribed largely by clinicians unfamiliar with ritonavir. Coronavirus disease 2019 (COVID-19) affects people with comorbid conditions and polypharmacy who could benefit from therapy, but prescriber uncertainty surrounding the appropriate management of DDIs was a barrier to the use of nirmatrelvir\/ritonavir. To support clinicians, the National Institutes of Health (NIH) panel on COVID-19 guidelines, the Ontario COVID-19 Science Advisory Table, and the University of Liverpool independently developed prescribing guidelines. Ultimately, the groups united to establish the LiON-PK (Liverpool-Ontario-NIH Pharmacokinetics) collaboration. Here we describe how the team developed pragmatic and harmonized guidance for managing DDIs with nirmatrelvir\/ritonavir. This framework may inform development of prescribing resources for other complex medications or for future pandemic preparedness.<\/jats:p>","DOI":"10.1093\/cid\/ciaf606","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T13:06:49Z","timestamp":1761916009000},"page":"e446-e454","source":"Crossref","is-referenced-by-count":0,"title":["International Collaboration to Develop and Harmonize Drug Interaction Guidance for Nirmatrelvir\/Ritonavir During COVID-19: Lessons Learned for Future Pandemic Preparedness"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4076-6276","authenticated-orcid":false,"given":"Safia","family":"Kuriakose","sequence":"first","affiliation":[{"name":"Clinical Research Directorate, Frederick National Laboratory for Cancer Research , Frederick, Maryland 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University of Michigan , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9406-693X","authenticated-orcid":false,"given":"Kimberly K","family":"Scarsi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center , Omaha, Nebraska ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saye H","family":"Khoo","sequence":"additional","affiliation":[{"name":"Centre for Experimental Therapeutics, University of Liverpool , Liverpool ,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Pau","sequence":"additional","affiliation":[{"name":"Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland 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