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      Remdesivir-Induced Bradycardia


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          Remdesivir inhibits the viral RNA–dependent RNA polymerase, thereby interrupting the viral replication process. It decreases the time to recovery in hospitalized coronavirus disease 2019 patients with lower respiratory tract infections; however, older adult patients with underlying cardiovascular disease and those taking beta-blockers, when treated with remdesivir, have bradycardia as an adverse effect. This article provides a brief overview of remdesivir-induced bradycardia, diagnosis, and treatment.


          Remdesivir, a viral RNA–dependent RNA polymerase inhibitor, found extensive use in coronavirus disease 2019–infected patients because it curbs the viral load expansion. Among patients hospitalized as a result of lower respiratory tract infection, remdesivir proved to improve recovery time; however, remdesivir also can induce significant cytotoxic effects on cardiac myocytes. In this narrative review, we discuss the pathophysiological mechanism of remdesivir-induced bradycardia and diagnostic and management strategies for these patients. We conclude that further research is necessary to understand better the mechanism of bradycardia in coronavirus disease 2019 patients with or without cardiovascular disorder treated with remdesivir.

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          Most cited references13

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          Remdesivir for the Treatment of Covid-19 — Final Report

          Abstract Background Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (Covid-19), none have yet been shown to be efficacious. Methods We conducted a double-blind, randomized, placebo-controlled trial of intravenous remdesivir in adults hospitalized with Covid-19 with evidence of lower respiratory tract involvement. Patients were randomly assigned to receive either remdesivir (200 mg loading dose on day 1, followed by 100 mg daily for up to 9 additional days) or placebo for up to 10 days. The primary outcome was the time to recovery, defined by either discharge from the hospital or hospitalization for infection-control purposes only. Results A total of 1063 patients underwent randomization. The data and safety monitoring board recommended early unblinding of the results on the basis of findings from an analysis that showed shortened time to recovery in the remdesivir group. Preliminary results from the 1059 patients (538 assigned to remdesivir and 521 to placebo) with data available after randomization indicated that those who received remdesivir had a median recovery time of 11 days (95% confidence interval [CI], 9 to 12), as compared with 15 days (95% CI, 13 to 19) in those who received placebo (rate ratio for recovery, 1.32; 95% CI, 1.12 to 1.55; P<0.001). The Kaplan-Meier estimates of mortality by 14 days were 7.1% with remdesivir and 11.9% with placebo (hazard ratio for death, 0.70; 95% CI, 0.47 to 1.04). Serious adverse events were reported for 114 of the 541 patients in the remdesivir group who underwent randomization (21.1%) and 141 of the 522 patients in the placebo group who underwent randomization (27.0%). Conclusions Remdesivir was superior to placebo in shortening the time to recovery in adults hospitalized with Covid-19 and evidence of lower respiratory tract infection. (Funded by the National Institute of Allergy and Infectious Diseases and others; ACTT-1 ClinicalTrials.gov number, NCT04280705.)
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            Cardiac Adverse Events With Remdesivir in COVID-19 Infection

            Since December 2019, coronavirus has gradually progressed to a pandemic with no efficacious treatment. Remdesivir is an antiviral medication and inhibitor of viral RNA dependent RNA polymerase with inhibitory action against SARS-CoV virus. Two patients diagnosed with coronavirus infection with worsening respiratory status were initiated with multimodality therapy with antibiotics, steroids and remdesivir. After initiation of remdesivir, the patients’ developed bradycardia, with one of the two also showing signs of worsening QT interval. This reverted upon stopping remdesvir therapy. The prevalence of bradycardia with prolonged QT interval is not well-known yet with this medication.
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              The evaluation and management of bradycardia.


                Author and article information

                South Med J
                South Med J
                Southern Medical Journal
                Lippincott Williams & Wilkins
                March 2023
                2 March 2023
                2 March 2023
                : 116
                : 3
                : 317-320
                From [1 ]Osmania Medical College, Hyderabad, India
                [2 ]Tianjin Medical University, Tianjin, P.R. China
                [3 ]Avalon University School of Medicine, Willemstad, Curacao
                [4 ]Dayanand Medical College and Hospital, Ludhiana, India
                [5 ]Department of Internal Medicine, Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
                [6 ]Associate Professor, Avalon University School of Medicine, Willemstad, Curacao.
                Author notes
                [*]Correspondence to Dr Meet A. Patel, Tianjin Medical University, Tianjin Province - 300070, P.R. China. E-mail: meetapatel13@ 123456gmail.com . To purchase a single copy of this article, visit sma.org/smj. To purchase larger reprint quantities, please contact reprintsolutions@ 123456wolterskluwer.com .
                SMJ_220323 00013
                Copyright © 2023 by The Southern Medical Association

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                : 05 October 2022
                Medicine & Medical Specialties

                bradycardia, cardiotoxicity, covid-19, remdesivir


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