COVID-19 and the burning issue of drug interaction: never forget the ECG

Abstract

The coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), has been rapidly escalating, becoming a relevant threat to global health. Being a recent virus outbreak, there are still no available therapeutic regimens that have been approved in large randomised trials and so patients are currently being treated with multiple drugs. This raises concerns regarding drug interaction and their implication in arrhythmic burden. In fact, two of the actually used drugs against SARS-CoV2, such as chloroquine and the combination lopinavir/ritonavir, might determine a QT (the time from the start of the Q wave to the end of the T wave) interval prolongation and they show several interactions with antiarrhythmic drugs and antipsychotic medications, making them prone to an increased risk of developing arrhythmias. This brief review focuses the attention on the most relevant drug interactions involving the currently used COVID-19 medications and their possible association with cardiac rhythm disorders, taking into account also pre-existing condition and precipitating factors that might additionally increase this risk. Furthermore, based on the available evidence and based on the knowledge of drug interaction, we propose a quick and simple algorithm that might help both cardiologists and non-cardiologists in the management of the arrhythmic risk before and during the treatment with the specific drugs used against SARS-CoV2.

Evaluation of potential drug-drug interactions and polypharmacy in hospitalized COVID-19 patients

“…HCQ-Escitalopram interaction may lead to prolongation of the QT interval. The use of quick and simple algorithms that might help clinicians in the management of arrhythmic risk before and during treatment with the specific drugs used against SARS-CoV2 may be considered 26 .…”

COVID-19 and arrhythmia: An overview

“…Some risk factors may predispose COVID-19 patients to arrhythmias: hypoxia that can be brought on by pneumonia, electrolyte imbalances from renal failure, diuretics, and renal failure, acute myocardial injury which can be caused by infarction, myocarditis, sepsis, ARDS, acute renal failure, pulmonary embolism, and cardiotoxicity, and finally heart failure [11] . Underlying health conditions such as hypertension, diabetes, congenital heart problems, and thyroid problems may also increase this risk.…”

High Prevalence of Potential Drug-Drug Interactions Among Patients Treated with Off-label Therapies for COVID-19

“…According to our data, a high proportion of patients were at risk for clinically relevant DDIs that could lead to serious side effects such as arrhythmias, respiratory depression, severe hypoglycemia, and rhabdomyolysis. Indeed, these potential DDIs have been alerted by previous authors and medical societies raising concerns regarding the safety profile of these drugs (12)(13)(14)20).…”