Potential COVID-19 drug azithromycin may increase risk for cardiac
events
Risks exist if drug is taken with other commonly prescribed medications


Date:
September 16, 2020
Source:
University of Illinois at Chicago
Summary:
Azithromycin -- a commonly-prescribed antibiotic -- also is being
investigated as a potential treatment for COVID-19. Researchers
have found that azithromycin by itself is not associated with an
increase in cardiac events; however, if the drug is taken with
certain other drugs that affect the electrical functioning of the
heart, then cardiac events increased.



FULL STORY ========================================================================== Debates over whether hydroxychloroquine should be taken to help lessen the duration and impact of COVID-19 have revolved around the drug's reputation
for causing cardiac events such as abnormal heart rhythms or beats and
cardiac arrest. Because of this, the U.S. Food and Drug Administration
has revoked emergency use authorization for the drug in treating COVID-19.


========================================================================== Another drug, azithromycin -- a commonly-prescribed antibiotic -- also is
being investigated as a potential treatment for COVID-19. Azithromycin's association with cardiac events also has been debated. In 2012, the FDA
issued a warning for azithromycin stating that it had been linked to
cardiac events, but subsequent studies have yielded mixed results.

Now, researchers from the University of Illinois Chicago have found that azithromycin by itself is not associated with an increase in cardiac
events; however, if the drug is taken with certain other drugs that affect
the electrical functioning of the heart, then cardiac events increased.

"Our findings should give researchers and clinicians looking at
azithromycin as a potential treatment for COVID-19 pause," said
Haridarshan Patel, a researcher in the department of pharmacy systems,
outcomes and policy at the UIC College of Pharmacy and corresponding
author on the paper. "We found that if taken together with drugs
that affect the electrical impulses of the heart, the combination is
linked with a 40% increase in cardiac events, including fainting, heart palpitations and even cardiac arrest." Their findings are published
JAMA Network Open.

Drugs that affect the electrical impulses of the heart, specifically the interval in the electrical rhythm called the QT interval, are called QT- prolonging drugs. These drugs include blood pressure medications such
as ACE inhibitors and beta-blockers, some antidepressants, anti-malaria
drugs such as hydroxychloroquine and chloroquine, opioid medications
and even muscle relaxers.



========================================================================== "Because QT-prolonging drugs are used so commonly, our findings suggest
that doctors prescribing azithromycin should be sure that patients are
not also taking a QT-prolonging drug," Patel said.

In a previous study, Patel and colleagues found that one in five people prescribed azithromycin also were taking a QT-prolonging drug.

Previous studies looking at azithromycin and cardiac events examined
specific populations that tend to be older and have more health issues, including Medicaid patients and veterans. But in this study, Patel and colleagues used a large database containing medical data on millions of patients in the United States with a mean age of 36 years old.

The risk of cardiac events with azithromycin was evaluated against
amoxicillin, another antibiotic that has never been linked to cardiac
events and which has no impact on the QT-interval. The researchers
looked at data from more than 4 million patients enrolled in private
health insurance plans who were hospitalized or visited an emergency
department for a cardiac event between 2009 and 2015 who started taking
either amoxicillin or azithromycin within five days of their hospital
visit. There were approximately 2 million episodes in each group. Cardiac events included ventricular arrhythmias, fainting, palpitations and
cardiac arrest, and death.

"Drugs often prolong QT-interval but may not necessarily result in
cardiac events that self-resolve over time," Patel said. "We looked at
events that led to emergency department visits or hospitalizations in
this study." The researchers found that the likelihood of cardiac events
with azithromycin compared with amoxicillin were not significantly higher,
and these events actually were quite low or rare in both groups, with
the most common cardiac events being fainting and palpitations. However,
among patients taking both a QT-prolonging medication and azithromycin together, the risk of cardiac events was 40% higher compared with the amoxicillin group.

"Because both QT-prolonging drugs and azithromycin are so commonly
prescribed, the risk for cardiac events due to the combination,
while still rare, is serious," Patel said. "Studies looking at using azithromycin to treat COVID-19 or other diseases should very carefully
consider its use among patients who are also taking QT-prolonging
medications." Gregory Calip, Robert DiDomenico, Glen Schumock and Todd
Lee of the UIC College of Pharmacy and Katie Suda of the University of Pittsburgh are co-authors on the study.


========================================================================== Story Source: Materials provided by
University_of_Illinois_at_Chicago. Original written by Sharon
Parmet. Note: Content may be edited for style and length.


========================================================================== Journal References:
1. Haridarshan Patel, Gregory S. Calip, Robert J. DiDomenico, Glen T.

Schumock, Katie J. Suda, Todd A. Lee. Comparison of Cardiac Events
Associated With Azithromycin vs Amoxicillin. JAMA Network Open,
2020; 3 (9): e2016864 DOI: 10.1001/jamanetworkopen.2020.16864
2. Haridarshan Patel, Gregory Sampang Calip, Robert J. DiDomenico,
Glen T.

Schumock, Katie J. Suda, Todd A. Lee. Prevalence of Cardiac Risk
Factors in Patients Prescribed Azithromycin before and after
the 2012 FDA Warning on the Risk of Potentially Fatal Heart
Rhythms. Pharmacotherapy: The Journal of Human Pharmacology and
Drug Therapy, 2020; 40 (2): 107 DOI: 10.1002/phar.2355 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/09/200916113422.htm

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