Lopinavir/ritonavir

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Bradyarrhythmia following an off-label use : case report A 74-year-old woman developed bradyarrhythmia during off-label treatment with lopinavir/ritonavir for COVID-19. The woman, who had hypertension and chronic obstructive pulmonary disease, was admitted with complaints of dyspnoea, cough and fatigue. She was eventually diagnosed with COVID-19. She thus started receiving off-label treatment with lopinavir/ ritonavir 800/200mg (lopinavir 800mg/ritonavir 200mg) daily [route not stated], along with various other concomitant medications. On the third day of the antiviral therapy, she suddenly developed dizziness, nausea and general malaise. She was found to be disorientated, and her heart rate was found to be slow. She developed brain injury, classified as moderate (the Glasgow Coma Scale was 12 points). An ECG showed sinus arrest with junctional escape rhythm 36 bpm. The high sensitivity troponin, serum electrolytes, glomerular filtration rate, blood PH, PCO2, PO2 and oxygen saturation were found to be normal. The woman was treated with atropine [atropine sulphate] and IV dopamine 5–6 mkg/kg/min. However, no effect was noted on the heart rate. It was determined that she developed bradyarrhythmia in form of sinus arrest, and the off-label therapy with lopinavir/ ritonavir was suspected as contributing factor in the development of bradyarrhythmia and sinus arrest. Additionally, the brain injury was also thought to be due to toxic effects of lopinavir/ritonavir. Lopinavir/ritonavir was therefore stopped, and she underwent insertion of a temporary pacemaker. Within 72 hours, restoration of the normal sinus rhythm was noted. Fourteen days later, she was discharged in stable condition. An ECG after one month demonstrated normal sinus rhythm. Tlegenova ZH, et al. Severe bradyarrhythmia requiring temporary pacemaker in a COVID-19 patient receiving lopinavir/ritonavir treatment: A case report. Heart, Vessels and 803517281 Transplantation 4: No. 2, May 2020. Available from: URL: http://doi.org/10.24969/HVT.2020.198

0114-9954/20/1832-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

Reactions 28 Nov 2020 No. 1832

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