In a new study, researchers found that COVID-19 drugs hydroxychloroquine and azithromycin may have a serious impact on the heart and are a potentially lethal combination.
They did a large analysis of a World Health Organization database on adverse drug reactions.
The research was conducted by a team at the Vanderbilt University Medical Center and elsewhere.
The team did a meta-analysis of a WHO database encompassing more than 21 million adverse event case reports from more than 130 countries between November 14, 1967, and March 1, 2020, mainly before the COVID-19 pandemic.
The study compared heart adverse-drug-reactions (CV-ADRs) in patients who received hydroxychloroquine, azithromycin or the combination of both medications with all other cardiovascular medications in the database.
Hydroxychloroquine and azithromycin, alone or in combination, have been proposed for the treatment of COVID-19 patients.
From the more than 21 million case reports of adverse drug reactions, the researchers extracted case reports for hydroxychloroquine and azithromycin, alone or in combination:
They found 76,822 adverse event reports were linked to hydroxychloroquine alone, and in 28.4% of those cases (21,808), hydroxychloroquine was suspected to be linked to the adverse event;
In addition, 89,692 adverse event reports were associated with azithromycin alone, and in 60.8% of those cases (54,533), azithromycin was suspected to be associated with the adverse event; and
607 adverse event reports reported were associated with the combination of both medications.
Hydroxychloroquine was also strongly linked to the development of conduction disorders (atrioventricular block and bundle branch block) and heart failure.
Azithromycin monotherapy was linked to greater side effects than hydroxychloroquine alone.
The combination of the two drugs was linked to a greater reporting of side effects than either medication alone.
The researchers say that side effects that trigger irregular heart rhythms have been described mainly with azithromycin but also with hydroxychloroquine.
Hydroxychloroquine was also linked to heart failure when usage was prolonged over several months.
While the absolute case numbers were low, these findings are important to bear in mind in the setting of COVID-19 patients who may present with additional risk factors for heart problems including inflammation with elevated interleukin-6, hypokalemia, numerous interacting medications, bradycardia, and higher hydroxychloroquine doses.
The study is published in Circulation.
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