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Rezaee H, Pourkarim F, Pourtaghi‐Anvarian S, Entezari‐Maleki T, Asvadi‐Kermani T, Nouri‐Vaskeh M. Drug-drug interactions with candidate medications used for COVID-19 treatment: An overview. Pharmacol Res Perspect 2021; 9:e00705. [PMID: 33421347 PMCID: PMC7796804 DOI: 10.1002/prp2.705] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023] Open
Abstract
Drug-drug interaction (DDI) is a common clinical problem that has occurred as a result of the concomitant use of multiple drugs. DDI may occur in patients under treatment with medications used for coronavirus disease 2019 (COVID-19; i.e., chloroquine, lopinavir/ritonavir, ribavirin, tocilizumab, and remdesivir) and increase the risk of serious adverse reactions such as QT-prolongation, retinopathy, increased risk of infection, and hepatotoxicity. This review focuses on summarizing DDIs for candidate medications used for COVID-19 in order to minimize the adverse reactions.
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Affiliation(s)
- Haleh Rezaee
- Infectious Diseases and Tropical Medicine Research CenterTabriz University of Medical SciencesTabrizIran
- Department of Clinical PharmacyFaculty of PharmacyTabriz University of Medical SciencesTabrizIran
| | - Fariba Pourkarim
- Department of Clinical PharmacyFaculty of PharmacyTabriz University of Medical SciencesTabrizIran
| | | | - Taher Entezari‐Maleki
- Department of Clinical PharmacyFaculty of PharmacyTabriz University of Medical SciencesTabrizIran
| | - Touraj Asvadi‐Kermani
- Department of SurgeryFaculty of MedicineTabriz University of Medical SciencesTabrizIran
| | - Masoud Nouri‐Vaskeh
- Immunology Research CenterTabriz University of Medical SciencesTabrizIran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMAUniversal Scientific Education and Research Network (USERNTehranIran
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Hodge D, Marra F, Marzolini C, Boyle A, Gibbons S, Siccardi M, Burger D, Back D, Khoo S. Drug interactions: a review of the unseen danger of experimental COVID-19 therapies. J Antimicrob Chemother 2020; 75:3417-3424. [PMID: 32750131 PMCID: PMC7454591 DOI: 10.1093/jac/dkaa340] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
As global health services respond to the coronavirus pandemic, many prescribers are turning to experimental drugs. This review aims to assess the risk of drug-drug interactions in the severely ill COVID-19 patient. Experimental therapies were identified by searching ClinicalTrials.gov for 'COVID-19', '2019-nCoV', '2019 novel coronavirus' and 'SARS-CoV-2'. The last search was performed on 30 June 2020. Herbal medicines, blood-derived products and in vitro studies were excluded. We identified comorbidities by searching PubMed for the MeSH terms 'COVID-19', 'Comorbidity' and 'Epidemiological Factors'. Potential drug-drug interactions were evaluated according to known pharmacokinetics, overlapping toxicities and QT risk. Drug-drug interactions were graded GREEN and YELLOW: no clinically significant interaction; AMBER: caution; RED: serious risk. A total of 2378 records were retrieved from ClinicalTrials.gov, which yielded 249 drugs that met inclusion criteria. Thirteen primary compounds were screened against 512 comedications. A full database of these interactions is available at www.covid19-druginteractions.org. Experimental therapies for COVID-19 present a risk of drug-drug interactions, with lopinavir/ritonavir (10% RED, 41% AMBER; mainly a perpetrator of pharmacokinetic interactions but also risk of QT prolongation particularly when given with concomitant drugs that can prolong QT), chloroquine and hydroxychloroquine (both 7% RED and 27% AMBER, victims of some interactions due to metabolic profile but also perpetrators of QT prolongation) posing the greatest risk. With management, these risks can be mitigated. We have published a drug-drug interaction resource to facilitate medication review for the critically ill patient.
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Affiliation(s)
- Daryl Hodge
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Fiona Marra
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Pharmacy, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Catia Marzolini
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Alison Boyle
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Pharmacy, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sara Gibbons
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Marco Siccardi
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - David Burger
- Radboud University Medical Centre, Nijmegen, the Netherlands
| | - David Back
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Saye Khoo
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Royal Liverpool University Hospital, Liverpool, UK
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Eslami P, Tabary M, Dooghaie-Moghadam A, Khaheshi I. How to overcome cardiovascular challenges in COVID-19 patients: a guide for common practice. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020021. [PMID: 32921718 PMCID: PMC7716966 DOI: 10.23750/abm.v91i3.9848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/25/2020] [Indexed: 01/19/2023]
Abstract
The COVID-19 epidemic initially started in Wuhan, China in December 2019 due to SARS-CoV-2. SARS-CoV-2 is genetically similar to the bat beta-coronavirus genus, but the novel specie of this genus can infect humans. The most common clinical features of COVID-19 are fever, cough, myalgia, fatigue, expectoration, and dyspnea. The primary reported mortality rate was about 2-3% in China; however, it reached up to 10% among patients with underlying cardiovascular diseases. The primary epidemiological investigations showed a high prevalence of underlying cardiovascular diseases in more than 40% of infected patients. A high prevalence of hypertension, ischemic heart disease, and diabetes were reported among deceased patients in Italy. Previous experiments in different pandemic situations showed that the cardiovascular system has been affected in many ways. Previous studies on SARS-CoV and MERS-CoV reported that cardiovascular co-morbidities had a direct correlation with the risk of infection, the severity of disease, and the mortality rate. Therefore, brief and available protocols for controlling the negative effects of this novel respiratory infection on the cardiovascular system, especially in a high-risk populations with underlying cardiovascular conditions, is one of the most serious concerns among healthcare providers. Herein, we aimed to review the available data on the cardiac manifestation of COVID-19. Besides, we described useful maps for the better treatment of COVID-19 infection in patients with underlying cardiovascular conditions, as a high-risk group of patients.
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Schiavone M, Gobbi C, Biondi-Zoccai G, D’Ascenzo F, Palazzuoli A, Gasperetti A, Mitacchione G, Viecca M, Galli M, Fedele F, Mancone M, Forleo GB. Acute Coronary Syndromes and Covid-19: Exploring the Uncertainties. J Clin Med 2020; 9:E1683. [PMID: 32498230 PMCID: PMC7356537 DOI: 10.3390/jcm9061683] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Since an association between myocardial infarction (MI) and respiratory infections has been described for influenza viruses and other respiratory viral agents, understanding possible physiopathological links between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and acute coronary syndromes (ACS) is of the greatest importance. The initial data suggest an underestimation of ACS cases all over the world, but acute MI still represents a major cause of morbidity and mortality worldwide and should not be overshadowed during the coronavirus disease (Covid-19) pandemic. No common consensus regarding the most adequate healthcare management policy for ACS is currently available. Indeed, important differences have been reported between the measures employed to treat ACS in China during the first disease outbreak and what currently represents clinical practice across Europe and the USA. This review aims to discuss the pathophysiological links between MI, respiratory infections, and Covid-19; epidemiological data related to ACS at the time of the Covid-19 pandemic; and learnings that have emerged so far from several catheterization labs and coronary care units all over the world, in order to shed some light on the current strategies for optimal management of ACS patients with confirmed or suspected SARS-CoV-2 infection.
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Affiliation(s)
- Marco Schiavone
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
- University of Milan, 20122 Milan, Italy;
| | | | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy;
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Fabrizio D’Ascenzo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy;
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Medical Sciences, AOUS Le Scotte Hospital, University of Siena, 53100 Siena, Italy;
| | - Alessio Gasperetti
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
| | - Gianfranco Mitacchione
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
| | - Maurizio Viecca
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
| | - Massimo Galli
- Department of Infectious Diseases, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy;
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Francesco Fedele
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome, 00161 Rome, Italy;
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome, 00161 Rome, Italy;
| | - Giovanni Battista Forleo
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
- University of Milan, 20122 Milan, Italy;
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DeCarolis DD, Chen YC, Westanmo AD, Conley C, Gravely AA, Khan FB. Decreased warfarin sensitivity among patients treated with elbasvir and grazoprevir for hepatitis C infection. Am J Health Syst Pharm 2019; 76:1273-1280. [PMID: 31418789 DOI: 10.1093/ajhp/zxz127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE We previously reported an interaction with warfarin anticoagulation when initiating treatment with direct-acting antiviral agents for hepatitis C infection. A decreased warfarin sensitivity led to subtherapeutic anticoagulation. To study this interaction further, we expanded our research to include patients treated with the combination of elbasvir and grazoprevir concurrent with warfarin anticoagulation and investigated changes in warfarin sensitivity during and after treatment. METHODS Using electronic health records of the Veterans Health Administration, patients starting treatment with elbasvir-grazoprevir for hepatitis C infection concurrent with warfarin anticoagulation were identified. Inclusion required stable warfarin anticoagulation prior to 12 weeks of treatment with elbasvir-grazoprevir. A warfarin sensitivity index (WSI) was calculated at the start of treatment, after 12 weeks after treatment, and at the end of treatment. The primary endpoint was the difference in WSI from pre- to end-treatment. The secondary endpoint was the WSI difference from before treatment to Changes in International Normalized Ratio, warfarin doses, and time in therapeutic range were measured. RESULTS In the final sample of 43 patients, the mean WSI decreased during treatment from 0.53 to 0.40, or 25.2%. After treatment, the mean WSI rose to 0.51. Although the mean weekly warfarin dose increased from 40.3 to 44.6 mg during treatment, the mean International Normalized Ratio decreased from 2.40 to 1.96, recovering to 2.59 after treatment. The time spent in therapeutic range decreased from 74.1% before treatment to 39.8% during treatment and back to 64.9% 12 weeks posttreatment. CONCLUSION When elbasvir-grazoprevir was added to stable warfarin anticoagulation, warfarin sensitivity decreased significantly during treatment and returned to baseline after treatment.
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Affiliation(s)
| | - Yi-Chieh Chen
- Pharmacy, Mayo Clinic Health System-Austin, Austin, MN
| | | | | | - Amy A Gravely
- Research Service, Minneapolis VA Health Care System, Minneapolis, MN
| | - Fatima B Khan
- Department of Hematology/Oncology, Minneapolis VA Health Care System, Minneapolis, MN
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Rindone JP, Mellen CK. Reduction in warfarin effect associated with sofosbuvir-velpatasvir. Am J Health Syst Pharm 2019; 74:1308-1311. [PMID: 28842460 DOI: 10.2146/ajhp170324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Joseph P Rindone
- Clinical Pharmacy SectionNorthern Arizona VA Health Care SystemPrescott,
| | - Chadwick K Mellen
- Clinical Pharmacy SectionNorthern Arizona VA Health Care SystemPrescott, AZ
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