Antiarrhythmic agents
HCLQ, a derivative of chloroquine, is notoriously known for drug-induced
QT prolongation.35,40,41,42Moreover, azithromycin also
induces QT prolongation.35 The administration of
antiarrhythmic agents, including amiodarone, dronedarone, flecainide and
propafenone with HCLQ or azithromycin may further increase the risk of
QT prolongation and induce ventricular tachyarrhythmia or sudden cardiac
death (Table 1). Therefore, ECG monitoring for the QT interval is
important. Drugs should be either withheld or removed if QT interval is
longer than 500ms as generally recommended. The increased plasma level
of antiarrhythmic agents while being used with these antiviral drugs
would potentially increase the risk of malignant arrhythmias and sudden
cardiac death.
In addition to ventricular tachyarrhythmia, co-administration of
antiarrhythmic agents and investigational COVID-19 medications could
increase the blood concentration of class Ic and class III
antiarrhythmic drugs, and expose the patients to risk of atrial
proarrhythmic events. The increased blood concentration of class Ic and
III antiarrhythmic agents, including propafenone and amiodarone, would
change conduction properties of the atrial tissue. For example,
persistent atrial flutter may occur with the increase of atrial
refractory period.43,44,45