Drug interactions between AF medications and proposed COVID-19 treatment
Many investigational drugs have been proposed for COVID-19. Safety alerts due to drug side effects including long QT interval and ventricular arrhythmias were raised for HCLQ and azithromycin.35This red flag should be emphasized more while these drugs were prescribed along with AF medications for rate and rhythm control. AF medications include β-blockers, non-dihydropyridines (DHP) calcium channel blockers (CCB), digoxin and antiarrhythmic agents.36The use of these medications increases the risk for serious side effects such as bradycardia, heart failure, long QT interval, or torsades de pointes. Therefore, the guideline of medical treatment for AF has been provided by the international consensus.36Drug-drug interaction between AF and COVID-19 medications might share common metabolism and side effects (Table 1). In addition to the evaluation of baseline renal function, liver function and ECG parameters when initiating medications, a thoughtful consideration of drug interactions, adjustment, and monitoring is critical for patient safety and therapeutic efficiency.