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Diabetes mellitus and ALT elevation following off-label use in COVID-19: case report A 46-year-old woman developed diabetes mellitus during off-label use of lopinavir/ritonavir, methylprednisolone sodium succinate and prednisone-acetate for COVID-19. Additionally, she also exhibited elevated ALT during off-label use of umifenovir for COVID-19 [routes not stated; not all dosages and durations of treatment to reactions onset not stated]. The woman, who had fever, presented to a hospital in China, and was initially treated with oseltamivir. Later, she was diagnosed with COVID-19. She was admitted to a hospital in China. She started receiving off-label therapy with lopinavir/ritonavir, interferon α-2b [recombinant human interferon α-2b] and unspecified glucocorticoids, and oseltamivir was also continued as an off-label therapy for COVID-19. Her blood sugar was found to be high during the hospital stay. She experienced aggravation of chest tightness and required non-invasive ventilation. She was transferred to another hospital due to a worsening of the pulmonary lesions. During second hospitalisation, she continued off-label use of lopinavir/ritonavir 0.5g twice daily (day 1–6) followed by umifenovir [Arbidol] 0.2g thrice daily (day 6–18), ribavirin 0.3g thrice daily, interferon-α 2b; 5 million IU twice daily, methylprednisolone sodium succinate 40 and 20mg once daily, 40mg, 30mg and 20mg twice daily (day 1–25) and prednisoneacetate tablet 15mg once daily and 10mg once daily (day 25–32). She also received various concomitant medications along with offlabel use of immuneglobulin [human immunoglobulin] 20g once daily (day 7–36) and thymalfasin 1.6mg once daily (day 2–3) for COVID-19. On day 10 of admission (9 February 2020), she experienced elevation of ALT, which was attributed to umifenovir. She also experienced further elevation of blood sugar. A diagnosis of glucocorticoids-induced diabetes mellitus was made, but a contributory role of lopinavir/ritonavir was also not excluded. The woman was treated with liver protectants and insulin, acarbose and metformin for lowering blood glucose level during hospitalisation. By the end of February 2020, she showed symptomatic improvement and her SARS-CoV-2 nucleic acid in sputum and feces returned negative. She started receiving off-label use of rifampicin capsule 0.5g every night (day 28–36), despite the unproven anticoronavirus effect. On 6 March 2020, blood glucose level was found to be 5.02 mmol/L and ALT was 31 U/L indicative of normalised levels. Li X, et al. Drug evaluation and pharmaceutical care in a critically ill COVID-19 patient. International Journal of Clinical Pharmacology and Therapeutics 58: 568-574, No. 803514242 10, Oct 2020. Available from: URL: http://doi.org/10.5414/CP203772

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