Review Article

Remdesivir-Induced Bradycardia

Authors: Sai Gautham Kanagala, MBBS, Hardeep Dholiya, MBBS, Poonam Jhajj, BS, Meet A. Patel, MBBS, Vasu Gupta, MBBS, Sachin Gupta, MD, Shiau-ing Wu, MD, Rohit Jain, MD

Abstract

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.

 
Posted in: Infectious Disease136

Full Article

Having trouble viewing the article content below? Click here to open it directly.

Images

Download Image

Download Image

Download Image

References

1. Gubitosa JC, Kakar P, Gerula C, et al. Marked sinus bradycardia associated with remdesivir in COVID-19: a case and literature review. JACC Case Rep 2020;2(14):2260–2264.
 
2. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of Covid-19—final report. N Engl J Med 2020;383:1813–1826.
 
3. Mangrum JM, DiMarco JP. The evaluation and management of bradycardia. N Engl J Med 2000;342:703–709.
 
4. Sidhu S, Marine JE. Evaluating and managing bradycardia. Trends Cardiovasc Med 2020;30:265–272.
 
5. Nabati M, Parsaee H. Potential cardiotoxic effects of remdesivir on cardiovascular system: a literature review. Cardiovasc Toxicol 2022;22:268–272.
 
6. Ching PR, Lee C. Remdesivir-associated bradycardia. BMJ Case Rep 2021; 14:e245289.
 
7. Humeniuk R, Mathias A, Kirby BJ, et al. Pharmacokinetic, pharmacodynamic, and drug-interaction profile of remdesivir, a SARS-CoV-2 replication inhibitor. Clin Pharmacokinet 2021;60:569–583.
 
8. National Center for Biotechnology Information—PubChem. Compound summary: remdesivir. https://pubchem.ncbi.nlm.nih.gov/compound/Remdesivir. Accessed June 20, 2022.
 
9. Gupta AK, Parker BM, Priyadarshi V, et al. Cardiac adverse events with remdesivir in COVID-19 infection. Cureus 2020;12:e11132.
 
10. Touafchia A, Bagheri H, Carrié D, et al. Serious bradycardia and remdesivir for coronavirus 2019 (COVID-19): a new safety concerns. Clin Microbiol Infect 2021;27:791.e5–791.e8.
 
11. Day LB, Abdel-Qadir H, Fralick M. Bradycardia associated with remdesivir therapy for COVID-19 in a 59-year-old man. CMAJ 2021;193: E612–E615.
 
12. Mustafa SJ, Morrison RR, Teng B, et al. Adenosine receptors and the heart: role in regulation of coronary blood flow and cardiac electrophysiology. Handb Exp Pharmacol 2009(193):161–188.
 
13. Jacinto JP, Patel M, Goh J, et al. Remdesivir-induced symptomatic bradycardia in the treatment of COVID-19 disease. HeartRhythm Case Rep 2021;7:514–517.
 
14. Soni R; Drug Information Group. What literature is available describing the occurrence of bradycardia with remdesivir? https://dig.pharmacy.uic.edu/faqs/2021-2/october-2021-faqs/what-literature-is-available-describing-the-occurrence-of-bradycardia-with-remdesivir/. Accessed June 20, 2022.
 
15. Attena E, Albani S, Maraolo AE, et al. Remdesivir-induced bradycardia in COVID-19: a single center prospective study. Circ Arrhythm Electrophysiol 2021;14:e009811.
 
16. Hafeez Y, Grossman SA. Sinus Bradycardia. Treasure Island, FL: StatPearls Publishing; 2022.