Remdesivir therapy associated with Bradycardia in <scp>SARS‐CoV2</scp>

Kumar, Sabina; Arcuri, Christina; Chaudhuri, Sumanta; Gupta, Rahul; Aseri, Mahendra; Barve, Pranav; Shah, Shivang

doi:10.1002/clc.23700

Cited by 5 publications

(7 citation statements)

References 9 publications

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“…A multicenter retrospective analysis showed COVID-19 patients with bradycardia had a significant increase in mortality [ 5 ]. Though this study did not involve remdesivir, multiple case reports are published showcasing remdesivir potentially causing bradycardia [ 6 ]. Unfortunately, the mechanism of remdesivir causing bradycardia is not well-established, but there are some theories found in the literature review.…”

Section: Discussionmentioning

confidence: 99%

Bradycardia Related to Remdesivir During COVID-19: Persistent or Permanent?

Maheshwari¹,

Athiraman²

2021

Cureus

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Remdesivir is an antiviral that inhibits RNA-dependent RNA polymerases of coronaviruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is a cornerstone of therapy for hospitalized patients with coronavirus disease 2019 (COVID-19), especially those worsening from a respiratory standpoint despite being started on antibiotics, dexamethasone, zinc, and vitamin C. This is a case report describing two COVID-19-positive patients with bradycardia after starting remdesivir. Once remdesivir was discontinued, one patient corrected to normal sinus rhythm, and the other continued with persistent bradycardia.

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Section: Discussionmentioning

confidence: 99%

Bradycardia Related to Remdesivir During COVID-19: Persistent or Permanent?

Maheshwari¹,

Athiraman²

2021

Cureus

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“…Наиболее частые побочные эффекты терапии ремдесивиром включают тошноту, рвоту, диарею и повышение активности печеночных ферментов АЛТ и АСТ [12][13][14][15][16][17][18][19]. Сообщалось о более серьезных и потенциально фатальных побочных эффектах, включая брадикардию и почечную не достаточность [20][21][22][23][24][25][26][27][28]…”

Section: Discussionunclassified

Evaluation of the association of CES1 (rs2244613) polymorphisms with the safety of remdesivir in hospitalized patients with COVID-19

et al. 2023

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Introduction. An outbreak of novel COVID-19 infection has become a real challenge for the entire human society, and first of all for the healthcare services. The development of new drugs is a complex and lengthy process. At the beginning of the pandemic, it forced an intensive study of well-known drugs for the therapy. Remdesivir was first investigated as a potential treatment for Ebola virus. After beginning of the COVID-19 pandemic, in vitro evaluations demonstrated its activity against SARS-CoV-2. Subsequent clinical studies showed the efficacy of remdesivir in shortening the time to recovery.Aim. To evaluate the effect of the carriage of polymorphic alleles of the CES1 gene (A > C, rs2244613) on the safety profile of remdesivir therapy.Materials and methods. A total of 154 patients hospitalized with coronavirus infection were included in the study. All patients received remdesivir as etiotropic therapy in the standard regimen: 200 mg on the first day followed by 100 mg daily for 5-10 days. In the course of observations, clinical and laboratory signs of adverse events were reported. Venous blood samples were collected from each patient for pharmacogenetic studies. Genotyping was performed using the real-time polymerase chain reaction technique. Statistical analysis: вata were analysed by using IBM SPSS Statistics, Version 23.0.Results. There were no significant associations of carriage of various CES1 variants with the frequency of adverse reactions (bradycardia, nausea, vomiting) and laboratory markers of adverse events (ALT, AST, creatinine levels).Conclusion. In our study, no association was found between the carriage of CES1 gene polymorphisms and the safety parameters of remdesivir in hospitalized patients with COVID-19. Further research into the possibilities of personalizing COVID-19 therapy through pharmacogenetic testing is needed.

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“…The exact mechanism of remdesivir-induced bradycardia is unknown. However, the proposed mechanisms include the following: (1) the active metabolite of remdesivir is a nucleoside triphosphate which is similar to adenosine triphosphate (ATP) and ATP itself has negative chronotropic effects on the sinoatrial (SA) node through vagal stimulation [ 19 ]; (2) the ATP metabolite adenosine binds the AV node and induces a negative chronotropic effect [ 13 , 19 ]; and (3) the binding of remdesivir to mitochondrial RNA polymerase can lead to cardiotoxicity [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Permanent Pacemaker Placement Secondary to Remdesivir Induced Bradycardia: A Case Report

Khan¹,

Mustafa²,

Elhosseiny³

et al. 2022

Cureus

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Remdesivir is approved by the FDA for the treatment of hospitalized coronavirus disease 2019 patients. It is known to be associated with transient bradycardia that resolves after discontinuation of the drug. We present a case of a 71-year-old male with a history of congestive heart failure, hypertension, and atrial flutter (rate controlled with carvedilol) presented for evaluation of worsening dyspnea, dry cough, and fatigue. His COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) was positive and his chest x-ray showed right mid-lung opacity. Oxygen saturation was 88% on room air. He was started on dexamethasone and remdesivir. Bradycardia was noted on telemetry monitoring 48 hours after starting remdesivir. Carvedilol was discontinued, but the bradycardia persisted. Heart rate reached a nadir of 38 beats per minute (bpm) three days after completion of remdesivir therapy. Due to persistent bradycardia, he received a dual-chamber cardiac pacemaker without any immediate complications. Three months later, his pacemaker interrogation showed 99% ventricular pacing. We recommend that extra caution should be taken when initiating remdesivir therapy in individuals with baseline conduction abnormalities due to the possibility of persistent bradycardia.

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Remdesivir therapy associated with Bradycardia in SARS‐CoV2

Cited by 5 publications

References 9 publications

Bradycardia Related to Remdesivir During COVID-19: Persistent or Permanent?

Bradycardia Related to Remdesivir During COVID-19: Persistent or Permanent?

Evaluation of the association of CES1 (rs2244613) polymorphisms with the safety of remdesivir in hospitalized patients with COVID-19

Permanent Pacemaker Placement Secondary to Remdesivir Induced Bradycardia: A Case Report

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