Urgent Guidance for Navigating and Circumventing the QTc-Prolonging and Torsadogenic Potential of Possible Pharmacotherapies for Coronavirus Disease 19 (COVID-19)

John R Giudicessi; Peter A Noseworthy; Paul A Friedman; Michael J Ackerman

doi:10.1016/j.mayocp.2020.03.024

Urgent Guidance for Navigating and Circumventing the QTc-Prolonging and Torsadogenic Potential of Possible Pharmacotherapies for Coronavirus Disease 19 (COVID-19)

Mayo Clin Proc. 2020 Jun;95(6):1213-1221. doi: 10.1016/j.mayocp.2020.03.024. Epub 2020 Apr 7.

Authors

John R Giudicessi¹, Peter A Noseworthy², Paul A Friedman², Michael J Ackerman³

Affiliations

¹ Department of Cardiovascular Medicine, Clinician-Investigator Training Program, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN.
² Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN.
³ Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN; Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN. Electronic address: ackerman.michael@mayo.edu.

Abstract

As the coronavirus disease 19 (COVID-19) global pandemic rages across the globe, the race to prevent and treat this deadly disease has led to the "off-label" repurposing of drugs such as hydroxychloroquine and lopinavir/ritonavir, which have the potential for unwanted QT-interval prolongation and a risk of drug-induced sudden cardiac death. With the possibility that a considerable proportion of the world's population soon could receive COVID-19 pharmacotherapies with torsadogenic potential for therapy or postexposure prophylaxis, this document serves to help health care professionals mitigate the risk of drug-induced ventricular arrhythmias while minimizing risk of COVID-19 exposure to personnel and conserving the limited supply of personal protective equipment.

Publication types

Practice Guideline
Research Support, Non-U.S. Gov't

MeSH terms

Anti-Infective Agents / administration & dosage
Anti-Infective Agents / adverse effects
Betacoronavirus / drug effects
Betacoronavirus / isolation & purification
COVID-19
Coronavirus Infections / drug therapy
Coronavirus Infections / epidemiology
Death, Sudden, Cardiac* / etiology
Death, Sudden, Cardiac* / prevention & control
Drug Combinations
Drug Monitoring / methods
Drug Repositioning / ethics
Drug Repositioning / methods
Electrocardiography / methods
Humans
Hydroxychloroquine* / administration & dosage
Hydroxychloroquine* / adverse effects
Long QT Syndrome* / chemically induced
Long QT Syndrome* / mortality
Long QT Syndrome* / therapy
Lopinavir* / administration & dosage
Lopinavir* / adverse effects
Pandemics
Pneumonia, Viral / drug therapy
Pneumonia, Viral / epidemiology
Risk Adjustment / methods*
Ritonavir* / administration & dosage
Ritonavir* / adverse effects
SARS-CoV-2
Torsades de Pointes* / chemically induced
Torsades de Pointes* / mortality
Torsades de Pointes* / therapy

Substances

Anti-Infective Agents
Drug Combinations
lopinavir-ritonavir drug combination
Lopinavir
Hydroxychloroquine
Ritonavir