News | Coronavirus (COVID-19) | September 17, 2020

COVID-19 Therapy Drug Azithromycin May Increase Risk for Cardiac Events

Risks exist if drug is taken with other commonly prescribed medications

COVID-19 Therapy Drug Azithromycin May Increase Risk for Cardiac Events

Getty Images

September 17, 2020 — Debates over whether hydroxychloroquine should be taken to help lessen the duration and impact of COVID-19 (SARS-CoV-2) have revolved around the drug’s reputation for causing abnormal heart rhythms and cardiac arrest. Because of this, the U.S. Food and Drug Administration (FDA) revoked its emergency use authorization for the drug in treating COVID-19.

Another drug, azithromycin, a commonly-prescribed antibiotic, also is being investigated as a potential treatment for COVID-19. Azithromycin’s association with cardiac events also has been debated. In 2013, the FDA issued a warning for azithromycin stating that it had been linked to cardiac events, but subsequent studies have yielded mixed results.

Now, researchers from the University of Illinois Chicago have found that azithromycin by itself is not associated with an increase in cardiac events. However, if the drug is taken with certain other drugs that affect the electrical functioning of the heart, then cardiac events increased.

“Our findings should give researchers and clinicians looking at azithromycin as a potential treatment for COVID-19 pause,” said Haridarshan Patel, a researcher in the department of pharmacy systems, outcomes and policy at the UIC College of Pharmacy and corresponding author on the paper. “We found that if taken together with drugs that affect the electrical impulses of the heart, the combination is linked with a 40% increase in cardiac events, including fainting, heart palpitations and even cardiac arrest.”

Their findings are published JAMA Network Open in the article "Comparison of Cardiac Events Associated With Azithromycin vs Amoxicillin."[1]

Drugs that affect the electrical impulses of the heart, specifically the interval in the electrocardiogram (ECG) called the QT interval, are called QT-prolonging drugs. These drugs include blood pressure medications such as ACE inhibitors and beta-blockers, some antidepressants, anti-malaria drugs such as hydroxychloroquine and chloroquine, opioid medications and even muscle relaxers.

“Because QT-prolonging drugs are used so commonly, our findings suggest that doctors prescribing azithromycin should be sure that patients are not also taking a QT-prolonging drug,” Patel said.

In a previous study, Patel and colleagues found that one in five people prescribed azithromycin also were taking a QT-prolonging drug.

Previous studies looking at azithromycin and cardiac events examined specific populations that tend to be older and have more health issues, including Medicaid patients and veterans. But in this study, Patel and colleagues used a large database containing medical data on millions of patients in the United States with a mean age of 36 years old.

The risk of cardiac events with azithromycin was evaluated against amoxicillin, another antibiotic that has never been linked to cardiac events and which has no impact on the QT-interval. The researchers looked at data from more than 4 million patients enrolled in private health insurance plans who were hospitalized or visited an emergency department for a cardiac event between 2009 and 2015 who started taking either amoxicillin or azithromycin within five days of their hospital visit. There were approximately 2 million episodes in each group. Cardiac events included ventricular arrhythmias, fainting, palpitations and cardiac arrest, and death.

“Drugs often prolong QT-interval but may not necessarily result in cardiac events that self-resolve over time,” Patel said. “We looked at events that led to emergency department visits or hospitalizations in this study.”

The researchers found that the likelihood of cardiac events with azithromycin compared with amoxicillin were not significantly higher, and these events actually were quite low or rare in both groups, with the most common cardiac events being fainting and palpitations. However, among patients taking both a QT-prolonging medication and azithromycin together, the risk of cardiac events was 40% higher compared with the amoxicillin group.

“Because both QT-prolonging drugs and azithromycin are so commonly prescribed, the risk for cardiac events due to the combination, while still rare, is serious,” Patel said. “Studies looking at using azithromycin to treat COVID-19 or other diseases should very carefully consider its use among patients who are also taking QT-prolonging medications.”

Gregory Calip, Robert DiDomenico, Glen Schumock and Todd Lee of the UIC College of Pharmacy and Katie Suda of the University of Pittsburgh are co-authors on the study.

 

Related Content on Cardiac Issues Related to COVID-19 Treatments:

VIDEO: Why QT-prolongation Occurs in COVID-19 Patients on Hydroxychloroquine and Azithromycin — Interview with Andrew D. Krahn, M.D.,

WHO Database Shows Serious Health Impact of Hydroxychloroquine and Azithromycin Being Used to Treat COVID-19

VIDEO: Overview of Hydroxychloroquine and FDA Warning in its use to Treat COVID-19 — Interview with Marianne Pop, Pharm.D.

FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine for COVID-19

WHO Database Shows Serious Health Impact of Hydroxychloroquine and Azithromycin Being Used to Treat COVID-19

 

COVID-19 Hydroxychloroquine Treatment Brings Prolonged QT Arrhythmia Issues

FDA Reports of Deaths and Injuries From Use of Antimalarial hydroxychloroquine in COVID-19 Patients

VIDEO: Cardiologists Manage Trial Testing if Hydroxychloroquine Protects Clinicians From COVID-19 — Interview with William O'Neill, M.D.

First Large-scale U.S. Study on Hydroxychloroquine COVID-19 Prophylaxis Begins in Detroit

AHA, ACC, HRS Caution Use of COVID-19 Therapies Hydroxychloroquine and Azithromycin in Cardiac Patients

 

Reference:

1. Haridarshan Patel, Gregory S. Calip, Robert J. DiDomenico, et al. Comparison of Cardiac Events Associated With Azithromycin vs Amoxicillin. JAMA Netw Open. 2020;3(9):e2016864. doi:10.1001/jamanetworkopen.2020.16864.

 

Related Content

#breakingnews The U.S. Food and Drug Administration (FDA) just granted full approval to the Pfizer/BioNTech Covid-19 vaccine for people age 16 and older. It is the first vaccine to be fully approved by the FDA, and experts say it is expected to open the door for further vaccine mandates.

Getty Images

News | Coronavirus (COVID-19) | August 23, 2021
August 23, 2021 — The U.S.
The American Heart Association announced its support this week for the CDC and FDA recommendation that immuno-compromised patients should receive a third dose of the Pfizer or Moderna COVID vaccines. Getty Images #AHA #coronavirus #COVID19

The American Heart Association announced its support this week for the CDC and FDA recommendation that immuno-compormised patients should receive a third dose of the Pfizer or Moderna COVID vaccines. Getty Images

News | Coronavirus (COVID-19) | August 18, 2021 | By Dave Fornell, Editor
August 18, 2021 — The U.S.
In an effort to contain COVID-19 and the new rapid spread of the delta virus across the U.S., a coalition of 10 cardiovascular societies issued a statement of support for healthcare systems requiring COVID-19 vaccines for its employees. ACC, HRS, ASNC, SCMR, SCCT, ASE, HFSA, STS, SCAI.

In an effort to contain COVID-19 and the new rapid spread of the delta virus across the U.S., a coalition of 10 cardiovascular societies issued a statement of support for healthcare systems requiring COVID-19 vaccines for its employees. 

Feature | Coronavirus (COVID-19) | July 30, 2021 | By Dave Fornell, Editor
July 30, 2021 — A coalition of 10 U.S.-based cardiovascular societies have issued a statement today in support of all
AHA president says COVID has a direct impact on the heart and preventive measures for heart disease largely went out the window during the pandemic

Getty Images

News | Coronavirus (COVID-19) | July 26, 2021
July 26, 2021 — Heart disease and stroke continue to kill more people in the U.S.
A new study with data from more than 10,000 COVID patients confirmed that patients taking statin medications had a 41 percent lower risk of in-hospital death from COVID-19.

A new study with data from more than 10,000 COVID patients confirmed that patients taking statin medications had a 41 percent lower risk of in-hospital death from COVID-19. Researchers believe statins, which attach to the ACE2 receptors, may block the virus from attaching to these same receptors. 

News | Coronavirus (COVID-19) | July 21, 2021
July 21, 2021 — In a new study from University of California San Diego School of Medicine, researchers have confirmed
New trial results from the international RAPID Trial show that administering a full dose of a standard blood thinner early to moderately ill hospitalized patients with COVID-19 could halt the thrombo-inflammation process and reduce the risk of severe disease and death. How to anticoagulate COVID patients. How to prevent thrombus in COVID patients.

New trial results from the international RAPID Trial show that administering a full dose of a standard blood thinner early to moderately ill hospitalized patients with COVID-19 could halt the thrombo-inflammation process and reduce the risk of severe disease and death. Getty Images
 

Feature | Coronavirus (COVID-19) | July 15, 2021
July 15, 2021 — COVID-19 is m
Diluting of a blood sample for real-time deformability cytometry testing. Researchers at the Max-Planck-Zentrum für Physik und Medizin in Erlangen. Germany, were able to show for the first time COVID-19 significantly changes the size and stiffness of red and white blood cells, sometimes over months. From the study How a COVID-19 Infection Changes Blood Cells in the Long Run. Reasons for long COVID.

Diluting of a blood sample for real-time deformability cytometry testing. Researchers at the Max-Planck-Zentrum für Physik und Medizin in Erlangen. Germany, were able to show for the first time COVID-19 significantly changes the size and stiffness of red and white blood cells, sometimes over months.

News | Coronavirus (COVID-19) | July 15, 2021
July 15, 2021 — Using real-time deformability cytometry, researchers at the...
Researchers analyzing surveillance data on 518 children and adolescents with MIS-C who were admitted to U.S. hospitals in 2020 fopiund those treated with intravenous immune globulin (IVIG) plus glucocorticoids had a lower risk of new or persistent cardiovascular dysfunction than IVIG alone. Left photo Getty Images, right photo Nemours Children’s Health System.

Researchers analyzing surveillance data on 518 children and adolescents with MIS-C who were admitted to U.S. hospitals in 2020 fopiund those treated with intravenous immune globulin (IVIG) plus glucocorticoids had a lower risk of new or persistent cardiovascular dysfunction than IVIG alone. Left photo Getty Images, right photo Nemours Children’s Health System.

News | Coronavirus (COVID-19) | June 28, 2021
June 28, 2021 - A recent analysis found that children and adolescents with multisystem inflammatory syndrome in child
The U.S. Food and Drug Administration (FDA) announced June 25 it has added a warning on the Moderna and Pfizer COVID-19 messenger RNA (mRNA) vaccine fact sheets to explain they may cause myocarditis in rare cases as a side effect. The agency said the side effect is very rare and patients generally recover quickly, but it can disportionally affect younger patients in their teens and early 20s. Getty Images

Getty Images

News | Coronavirus (COVID-19) | June 28, 2021 | Dave Fornell, Editor
June 28, 2021 — The U.S.
A small number of patients develop myocarditis after receiving the messenger RNA (mRNA) COVID-19 vaccines from Pfizer and Moderna. This recently raised concerns after numbers for this adverse reaction jumped in April and May, prompting review this week by the Centers for Disease Control and Prevention (CDC) Advisory Committee on the Immunization Practices (ACIP).

A small number of patients develop myocarditis after receiving the messenger RNA (mRNA) COVID-19 vaccines from Pfizer and Moderna. This recently raised concerns after numbers for this adverse reaction jumped in April and May, prompting review this week by the Centers for Disease Control and Prevention (CDC) Advisory Committee on the Immunization Practices (ACIP). Getty Images

Feature | Coronavirus (COVID-19) | June 24, 2021 | By Dave Fornell, Editor
A small number of patients develop inflammation leading to myocarditis after receiving the messenger RNA (mRNA)...