An elderly patient has been admitted in isolation ward with severe COVID-19 infection.
He developed new onset atrial fibrillation for which the cardiologists advised Bisoprolol and Amiodarone.
He is currently on dual oxygen and has rate controlled atrial fibrillation.
Should the treating physician be concerned regarding amiodarone use in this patient?
Amiodarone, one of the most widely prescribed antiarrhythmic drugs to treat both ventricular and supraventricular arrhythmias, has been identified as a candidate drug for use against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
A randomized study called ReCOVery-SIRIO has been started to evaluate the effects of amiodarone compared with usual care in symptomatic patients hospitalized with confirmed COVID-19 infection.
Arrhythmias, particularly AF, are common in COVID-19 patients, and amiodarone may be an effective and additive antiarrhythmic drug in these patients. Amiodarone is not free of secondary adverse effects, including the potential to cause pulmonary toxicity and fibrosis, thyroid disease, hepatic toxicity, increased creatine levels, QT interval prolongation, and bradyarrhythmia. Most of these adverse effects are more likely with long-term use of amiodarone.
A short-term use of amiodarone is relatively well tolerated. It may be speculated that amiodarone is more efficient with low viral loads and at the early stages of the COVID-19 infection. COVID-19 is characterized by Acute Lung Injury, and this could potentially be aggravated by long-term amiodarone administration.
Amiodarone may be a particularly effective antiarrhythmic agent for these hospitalized patients who are prone to supraventricular and ventricular arrhythmias, but only for shorter duration of treatment.
So, amiodarone is safe for short term use in Covid-19 infection?