Older, critically ill patients with COVID-19 may have increased risk of bradycardia with lopinavir and ritonavir

Date:
July 9, 2020
Source:
American Heart Association
Summary:
The combined use of antiretroviral medications lopinavir
and ritonavir, previously used to treat SARS-Cov-1 and
MERS-Cov patients, appeared to cause bradycardia in 22% of
elderly, critically ill COVID-19 patients, in a small study
in France. Bradycardia was resolved in all patients after
discontinuation or dose reduction of both medications.



FULL STORY ========================================================================== Older, critically ill patients with COVID-19 who received a combination
of the antiretroviral medications lopinavir and ritonavir experienced bradycardia, a slow heart rate, more often, according to new research
published today in Circulation: Arrhythmia and Electrophysiology, an
American Heart Association journal.


==========================================================================
The combination of antiretroviral medications lopinavir (LPV)
and ritonavir (RTV) have been previously used to treat patients with
SARS-Cov-1 and MERS-Cov, as well for HIV-1 patients. Among HIV-1 patients,
a risk of bradycardia was also reported.

In this small, preliminary, prospective study, researchers recorded
the risk of bradycardia in critically ill COVID-19 patients treated
with this combination of medications. Bradycardia is classified as
a heart rate below 60 beats per minute for a period of more than 24
hours. Bradycardia can cause problems if the slow heart rate leads to
a decrease in blood flow to the body. This can lead to heart failure,
fainting, chest pain and low blood pressure. In some people, bradycardia
does not cause any symptoms.

The study included 41 patients with COVID-19 admitted to the intensive
care unit at Amiens University Hospital, in Amiens, France, who were
treated with 200 mg LPV and 50 mg RTV twice daily for 10 days. All
patients received continuous electrocardiogram (ECG) monitoring.

Among the patients who received the LPV/RTV treatment:
* 22% experienced bradycardia for more than 24 hours; * bradycardia
occurred at least 48 hours after initiation of treatment,
indicating that the medications may have caused bradycardia;
* a blood test measuring the concentration of ritonavir (RTV plasma
concentration) at 72 hours after receiving the treatment showed
higher concentrations of RTV in the patients who had bradycardia;
* no correlation was found between RTV plasma concentration,
LPV plasma
concentration and mean heart rate at 3-days after LPV/RTV treatment
began;
* patients experiencing bradycardia were on average older than
patients
receiving the treatment who did not experience bradycardia (ages
62-80 vs. 54-68, respectively); and,
* bradycardia resolved after LPV/RTV were discontinued or doses were
reduced.

Researchers noted, "[LPV and RTV] have complex pharmacokinetic
characteristics [how the body processes a medication] ... Bradycardia
could be a sign of severe cardiological or neurological impairment
since it is associated with lymphopenia [lower than normal number
of white blood cells] that seems to reflect the severity of COVID-19
infection. Intensivists should be aware of this potential side effect
in order to closely monitor LPV/RTV plasma levels, notably in elderly patients." Co-authors are Christophe Beyls, M.D.; Nicolas Martin, M.D.;
Alexis Hermida, M.D.; Osama Abou-Arab, M.D., Ph.D.; and Yazine Mahjoub,
M.D., Ph.D. Author disclosures are in the manuscript.


========================================================================== Story Source: Materials provided by American_Heart_Association. Note:
Content may be edited for style and length.


==========================================================================


Link to news story: https://www.sciencedaily.com/releases/2020/07/200709121236.htm

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