QTc prolongation during antiviral therapy in two COVID‐19 patients

Zhu, Suyan; Wang, Jian; Wang, Yong; Chu, Jinguo; Liu, Yao; Chen, Xueqin; Chen, Xiaomin

doi:10.1111/jcpt.13183

Cited by 6 publications

(7 citation statements)

References 17 publications

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“…Two cases of increased QTc interval by administration of lopinavir/ritonavir combination reported by Zhu et al [42] provide further evidence on the relation of conduction abnormalities and antiviral drugs. In both cases, cessation of adverse effect causing drug leads to normalized QT intervals and eventual discharge from the hospital.…”

Section: Lopinavir/ritonavirmentioning

confidence: 65%

Safety profile of COVID-19 drugs in a real clinical setting

Chiu

Bhardwaj

Sah

2022

Eur J Clin Pharmacol

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Purpose The coronavirus disease 2019 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has affected millions all over the world and has been declared pandemic, as of 11 March 2020. In addition to the ongoing research and development of vaccines, there is still a dire need for safe and effective drugs for the control and treatment against the SARS-CoV-2 virus infection. Numerous repurposed drugs are under clinical investigations whose reported adverse events can raise worries about their safety. The aim of this review is to illuminate the associated adverse events related to the drugs used in a real COVID-19 setting along with their relevant mechanism(s). Method Through a literature search conducted on PubMed and Google Scholar database, various adverse events suspected to be induced by eight drugs, including dexamethasone, hydroxychloroquine, chloroquine, remdesivir, favipiravir, lopinavir/ ritonavir, ivermectin, and tocilizumab, administered in COVID-19 patients in clinical practice and studies were identified in 30 case reports, 3 case series, and 10 randomized clinical trials. Results Mild, moderate, or severe adverse events of numerous repurposed and investigational drugs caused by various factors and mechanisms were observed. Gastrointestinal side effects such as nausea, abdominal cramps, diarrhea, and vomiting were the most frequently followed by cardiovascular, cutaneous, and hepatic adverse events. Few other rare adverse drug reactions were also observed. ConclusionIn light of their ineffectiveness against COVID-19 as evident in large clinical studies, drugs including hydroxychloroquine, lopinavir/ritonavir, and ivermectin should neither be used routinely nor in clinical studies. While lack of sufficient data, it creates doubt regarding the reliability of chloroquine and favipiravir use in COVID-19 patients. Hence, these two drugs can only be used in clinical studies. In contrast, ample well-conducted studies have approved the use of remdesivir, tocilizumab, and dexamethasone under certain conditions in COVID-19 patients. Consequently, it is significant to establish a strong surveillance system in order to monitor the proper safety and toxicity profile of the potential anti-COVID-19 drugs with good clinical outcomes.

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Section: Lopinavir/ritonavirmentioning

confidence: 65%

Safety profile of COVID-19 drugs in a real clinical setting

Chiu

Bhardwaj

Sah

2022

Eur J Clin Pharmacol

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“…Interestingly, in this analysis, although critical QT prolongation was associated with higher risk of TdP, only treatment with LPN/RTV, simultaneous administration of amiodarone (known to prolong QT interval 52 ) or furosemide and hypokalemia could predict the occurrence of TdP in this cohort; instead, HCQ use was only modestly associated with TdP (0.3% of patients). Other cases of QT prolongation with LPN/RTV treatment have been described during the pandemic 53 , so that careful QTc duration evaluation and monitoring should be performed at baseline and during this drug therapy to identify patients at high risk of arrhythmias.…”

Section: Mechanisms Of Qt Prolongationmentioning

confidence: 99%

Arrhythmogenic Risk and Mechanisms of QT-Prolonging Drugs to Treat COVID-19

Schiavone

Gasperetti

Gherbesi

et al. 2022

Cardiac Electrophysiology Clinics

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“…However, due to its enzymatic properties, it could increase the plasma concentration of the co-administered drug (lopinavir); hence, it could increase the risk of hepatotoxicity. 30 A case study conducted by Zhu, et al 31 no studies have reported an association between corrected QT (QTc found a side effect of QT prolongation during the administration of lopinavir/ritonavir in COVID-19 patients. Because of the side effects caused by therapy, the complications must be given attention as they can affect the clinical condition of the patients.…”

Section: Side Effects Of Lopinavir/ritonavirmentioning

confidence: 99%

Study of Lopinavir/Ritonavir in Severe COVID-19 Patients with Comorbid Hypertension and Diabetes Mellitus

Didik Hasmono,

Ruth Marcelyna Ndoen,

Risa Septinia

et al. 2022

Indian Journal of Forensic Medicine & Toxicology

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Background: Lopinavir/ritonavir is an antiviral studied for its effectiveness in healing severe COVID-19 infection; however, it remains debated. This study determined the efficacy and evaluated the side effects of lopinavir/ ritonavir on severe COVID-19 patients with comorbid hypertension and diabetes mellitus.Methods: Retrospective data collection was conducted from June to December 2020. The data were then analyzed descriptively. Severe COVID-19 patients with hypertension and diabetes mellitus who received lopinavir/ ritonavir were grouped into groups A, B, C, D and observed based on other pharmaceutical therapies (antibiotics, corticosteroids, anticoagulants, multivitamins and supplements, comorbid therapy, and symptomatic therapy) obtained. The efficacy of lopinavir/ritonavir was identifiable through RT-PCR, oxygenation saturation, and chest X-ray. The side effects of lopinavir/ritonavir were also be evaluated. Results:Only 21 total sample met the inclusion criteria. The oral administration of lopinavir/ritonavir (2 x 400/100 mg) was effective in groups A, B, C, and D whose negative RT-PCR results were respectively 10%, 48%, 5%, and 14%; normal oxygen saturation with the administration of oxygen therapy was 10%, 33%, 5%, and 5%, respectively; and chest X-ray improvement was 10%, 29%, 5%, and 14%, respectively. Lopinavir/ritonavir could increase SGOT (46%), SGPT (27%), as well as a QT interval prolongation (5%). Conclusion:The administration of lopinavir/ritonavir is effective to rule out negative RTPCR results, improve chest X-ray imaging and oxygen saturation. Monitoring side effects merits more attention to avoid those potential side effects of the therapies.

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QTc prolongation during antiviral therapy in two COVID‐19 patients

Cited by 6 publications

References 17 publications

Safety profile of COVID-19 drugs in a real clinical setting

Safety profile of COVID-19 drugs in a real clinical setting

Arrhythmogenic Risk and Mechanisms of QT-Prolonging Drugs to Treat COVID-19

Study of Lopinavir/Ritonavir in Severe COVID-19 Patients with Comorbid Hypertension and Diabetes Mellitus

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