Antivirals Tied to Heart Issue in COVID Patients

FRIDAY July 10, 2020 (HealthDay News) – Older and critically ill COVID-19 patients who receive a combination of two common antiretroviral drugs may experience a drastic slowdown in their heart rates, French researchers report.

In their study of 41 patients treated with lopinavir and ritonavir twice a day for 10 days, 22% developed a condition of slow heartbeat called bradycardia. When the drugs were stopped or the doses lowered, the patients’ heart rates returned to normal, according to the CHU team in Amiens, France.

“Much research is underway to find effective therapies to treat patients infected with COVID-19,” said Dr. Gregg Fonarow, professor of cardiology at the University of California at Los Angeles, who had no part in the study.

The lopinavir-ritonavir combo has been seen as a promising treatment for COVID-19 based on very small reports, randomized clinical trials and off-label use, said Fonarow.

But previous studies have suggested that this combination can also cause heart blockage, a problem with electrical signals in the heart. “Determining how these drugs lead to bradycardia will require further study,” said Fonarow.

Doctors prescribing these drugs should be aware of the potential for bradycardia and monitor patients carefully, he added.

“In addition, the results of preliminary clinical trials suggest that this therapy is not effective in COVID-19, so its use in this setting will likely be very limited in the future,” said Fonarow.

Lopinavir and ritonavir have also been used to treat other viruses, including SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome) and HIV. The researchers noted that bradycardia was also observed in HIV patients treated with the drugs.

Normally, adults’ hearts beat between 60 and 100 times per minute. In bradycardia, the rate drops below 60 beats per minute, causing a decrease in blood flow which can cause fainting, chest pain, low blood pressure and heart failure.

The French study patients who developed the problem were older than those who did not, on average 62 to 80 years old, the researchers reported.

Dr. Marc Siegel, professor of medicine at the NYU Langone Medical Center in New York who reviewed the results, noted that the combination of two drugs had not helped COVID-19 patients in other recent trials.

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