Amiodarone in the COVID-19 Era: Treatment for Symptomatic Patients Only, or Drug to Prevent Infection?
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CURRENT OPINION
Amiodarone in the COVID‑19 Era: Treatment for Symptomatic Patients Only, or Drug to Prevent Infection? Fabian Sanchis‑Gomar1,2 · Carl J. Lavie3 · Daniel P. Morin3 · Carme Perez‑Quilis1 · Jari A. Laukkanen4,5 · Marco V. Perez2
© Springer Nature Switzerland AG 2020
Abstract Amiodarone, one of the most widely prescribed antiarrhythmic drugs to treat both ventricular and supraventricular arrhythmias, has been identified as a candidate drug for use against the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2). We present the rationale of using amiodarone in the COVID-19 scenario, as well as whether or not amiodarone administration represents a potential strategy to prevent SARS-CoV-2 infection, rather than simply used to treat patients already symptomatic and/or with severe coronavirus disease 2019 (COVID-19), based on current evidence.
Key Points Amiodarone has been identified as a candidate drug for use against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A multicenter study, the ReCOVery-SIRIO, is investigating the role of amiodarone in hospitalized patients with coronavirus disease 2019 (COVID-19) during the initial stages of infection. Evidence on amiodarone use in COVID-19 patients is still scarce; we need to stay cautious and remain attentive for new results to obtain more robust conclusions.
* Fabian Sanchis‑Gomar [email protected] 1
Department of Physiology, Faculty of Medicine, INCLIVA Biomedical Research Institute, University of Valencia, Av. Blasco Ibáñez, 15, 46010 Valencia, Spain
2
Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
3
John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
4
Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
5
Department of Medicine, Central Finland Health Care District, Jyvaskyla, Finland
While we wait for newly emerging evidence, both ventricular and supraventricular arrhythmias in COVID-19 patients should be treated with antiarrhythmic drugs in the same manner as patients who are not infected with COVID-19.
1 Introduction In the urgent search for effective therapies against coronavirus disease 2019 (COVID-19), a wide range of candidates has emerged as potential drugs to be incorporated into the therapeutic armamentarium. In this regard, the endocytic pathway
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has been targeted as a therapeutic strategy in COVID-19 [1]. Several groups have identified amiodarone as a candidate drug for use against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [2, 3]. Some have recommended administration of prophylactic intravenous amiodarone to mitigate the risk of sudden cardiac death (SCD) among patients infected with the novel SARS-CoV-2 [4]. A randomized study called ReCOVery-SIRIO has been started to evaluate the effects of amiodarone compared with usual care in symptomatic patients hospita
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