Potential drug–drug interactions in COVID 19 patients in treatment with lopinavir/ritonavir

Brandariz-Núñez, David; Correas-Sanahuja, Marcelo; Guarc, Eva; Picon, Rafael da Veiga Chaves; García, Bárbara; Gil, Rocio

doi:10.1016/j.medcle.2020.06.012

Cited by 14 publications

(14 citation statements)

References 19 publications

(17 reference statements)

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“…6 Within a few months, health authorities warned about health problems related to the management of these drugs in SARS-CoV-2 infection 7 and several studies have recently been published on serious cardiovascular events with the use of hydroxychloroquine, especially in combination with other medicines such as azithromycin, [8][9][10][11][12] as well as a study on pDDIs with lopinavir-ritonavir. 13 Nowadays, there are guides and websites where pDDIs can be checked. One of the most important is that produced by the "Liverpool Drug Interaction Group," made up of members of the Department of Pharmacology of the University of Liverpool in the United Kingdom in collaboration with the University Hospital of Basel (Switzerland) and Radboud IMC (Netherlands).…”

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

“…Thus, there are already publications with recommendations for the deprescription of these medicines, especially in patients over 65 years of age 6 . Within a few months, health authorities warned about health problems related to the management of these drugs in SARS‐CoV‐2 infection 7 and several studies have recently been published on serious cardiovascular events with the use of hydroxychloroquine, especially in combination with other medicines such as azithromycin, 8‐12 as well as a study on pDDIs with lopinavir‐ritonavir 13 …”

Section: What Is Known and Objectivementioning

confidence: 99%

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Real‐world prevalence and consequences of potential drug‐drug interactions in the first‐wave COVID‐19 treatments

Martínez-López-de-Castro

Samartín-Ucha

Paradela-Carreiro

et al. 2020

J Clin Pharm Ther

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What is known and objective: Initial treatment recommendations of COVID-19 were based on the use of antimicrobial drugs and immunomodulators. Although information on drug interactions was available for other pathologies, there was little evidence in the treatment of COVID-19. The objective of this study was to analyse the potential drug-drug interactions (pDDIs) derived from the medication used in COVID-19 patients in the first pandemic wave and to evaluate the real consequences of such interactions in clinical practice.Methods: Cohort, retrospective and single-centre study carried out in a third-level hospital. Adult patients, admitted with suspected COVID-19, that received at least one dose of hydroxychloroquine, lopinavir/ritonavir, interferon beta 1-b or tocilizumab and with any pDDIs according to "Liverpool Drug Interaction Group" between March and May 2020 were included. The possible consequences of pDDIs at the QTc interval level or any other adverse event according to the patient's medical record were analysed. A descriptive analysis was carried out to assess possible factors that may affect the QTc interval prolongation.Results and discussion: Two hundred and eighteen (62.3%) patients of a total of 350 patients admitted with COVID-19 had at least one pDDI. There were 598 pDDIs.Thirty-eight pDDIs (6.3%) were categorized as not recommended or contraindicated. The mean value difference between baseline and pDDI posterior ECG was 412.3 ms ± 25.8 ms vs. 426.3 ms ± 26.7 ms; p < 0.001. Seven patients (5.7%) had a clinically significant alteration of QTc. A total of 44 non-cardiological events (7.3%) with a possible connection to a pDDI were detected.

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Section: What Is K Nown and Objec Tivementioning

confidence: 99%

Section: What Is Known and Objectivementioning

confidence: 99%

Real‐world prevalence and consequences of potential drug‐drug interactions in the first‐wave COVID‐19 treatments

Martínez-López-de-Castro

Samartín-Ucha

Paradela-Carreiro

et al. 2020

J Clin Pharm Ther

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“…Most of the published papers on drug interactions in COVID patients consist of presenting potential interactions to which patients have been exposed after reviewing medical records 30 31 32 (no specific outcome). We have found 2 papers 33 34 with individual descriptions of the clinical cases presented in eTable 31 (use SuppInfo) .…”

Section: Resultsmentioning

confidence: 99%

Drug-drug Interactions between COVID-19 Treatments and Antidepressants, Mood Stabilizers/Anticonvulsants, and Benzodiazepines: Integrated Evidence from 3 Databases

et al. 2021

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Introduction The SARS-CoV-2 pandemic with psychiatric comorbidities leads to a scenario in which the use of psychotropic drugs may be required. This requires the support of evidence-based medicine to take into account possible interactions between antidepressants, mood stabilizers, benzodiazepines, and coronavirus infection treatments. Methods Three databases were consulted: (a) Lexicomp Drug Interactions, (b) Micromedex Solutions Drugs Interactions, (c)Liverpool Drug Interaction Group for COVID-19 therapies. The CredibleMeds QTDrugs List was also queried. Hydroxychloroquine, chloroquine, azithromycin, lopinavir-ritonavir, remdesivir, favipiravir, tocilizumab, baricitinib, anakinra, and dexamethasone – drugs used for SARS-CoV-2 – were analyzed, and consensus recommendations are made. Results The potential interactions of agomelatine, desvenlafaxine, duloxetine, milnacipran, and vortioxetine with COVID-19 treatments shall be considered less risky. Antidepressant interactions with hydroxychloroquine, chloroquine, and azithromycin enhance the risk of QT prolongation, and ECG monitoring is advised for most antidepressants. Antidepressants with lopinavir/ritonavir involve multiple CYP enzyme interactions (except with milnacipran). Gabapentin, oxcarbazepine, pregabalin, topiramate, and zonisamide are safe treatment options that have no significant interactions with COVID-19 treatments. Lithium is contraindicated with hydroxychloroquine, chloroquine, and azithromycin. Precaution should be taken in using valproic acid with lopinavir-ritonavir. The use of benzodiazepines does not present a risk of drug interaction with COVID-19 treatments, except lopinavir/ritonavir. Conclusions Clinicians prescribing antidepressants, mood stabilizers/anticonvulsants, and benzodiazepines, should be aware of the probable risk of drug-drug interaction with COVID-19 medications and may benefit from heeding these recommendations for use to ensure patient safety.

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“…Marginal analysis showed a protecting effect for death in ICU admitted patients with age more than 60. It was a new finding in this study; however, its side effects and drug-drug interactions should be regarded for using in such patients [ 9 ]. Some meta-analyses did not show a beneficial effect [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of Immune System-Related Medications on COVID-19 Outcome in a Cohort of Iranian Patients: Preliminary Report of a Data Mining Study

Bitaraf

Ahmadi

Gandomi‐Mohammadabadi

et al. 2021

Journal of Immunology Research

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Background. Regulation of the immune system is critical for fighting against viral infections. Both suppression and hyperactivity of the immune system result in failure of treatment. The present study was designed to show the effects of immune system-related medications on mortality and length of stay (LOS) in a cohort of Iranian patients with coronavirus disease 2019 (COVID-19). Methods. A data mining study was performed on 6417 cases of COVID-19 covered by 17 educational hospitals of Iran University of Medical Sciences, Tehran. Association of a researcher-designed drug list with death and LOS was studied. For death outcome, logistic regression was used reporting odds ratio (OR) with 95% confidence interval (CI). For LOS, right censored Poisson regression was used reporting incidence rate ratio (IRR) with 95% CI. Results. Among the corticosteroids, prednisolone was a risk factor on death ( OR = 1.41 , 95 % CI = 1.03 − 1.94 ). This association was increased after adjustment of age interactions ( OR = 3.45 , 95 % CI = 1.01 − 11.81 ) and was removed after adjustment of ICU admission interactions ( OR = 2.64 , 95 % CI = 0.70 − 9.92 ). Hydroxychloroquine showed a protecting effect on death ( OR = 0.735 , 95 % CI = 0.627 − 0.862 ); however, this association was removed after adjustment of age interactions ( OR = 0.76 , 95 % CI = 0.41 − 1.40 ). Among the antivirals, oseltamivir showed a protecting effect on death ( OR = 0.628 , 95 % CI = 0.451 − 0.873 ); however, this association was removed after adjustment of age interactions ( OR = 0.45 , 95 % CI = 0.11 − 1.82 ). For reduction of LOS, the only significant association was for hydroxychloroquine ( IRR = 0.85 , 95 % CI = 0.79 − 0.92 ). Conclusion. The results of such data mining studies can be used in clinics until completing the evidence. Hydroxychloroquine may reduce mortality in some specific groups; however, its association may be confounded by some latent variables and unknown interactions. Administration of corticosteroids should be based on the conditions of each case.

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Potential drug–drug interactions in COVID 19 patients in treatment with lopinavir/ritonavir

Cited by 14 publications

References 19 publications

Real‐world prevalence and consequences of potential drug‐drug interactions in the first‐wave COVID‐19 treatments

Real‐world prevalence and consequences of potential drug‐drug interactions in the first‐wave COVID‐19 treatments

Drug-drug Interactions between COVID-19 Treatments and Antidepressants, Mood Stabilizers/Anticonvulsants, and Benzodiazepines: Integrated Evidence from 3 Databases

Effects of Immune System-Related Medications on COVID-19 Outcome in a Cohort of Iranian Patients: Preliminary Report of a Data Mining Study

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