Bradycardia due to remdesivir: Report of two cases

Cebrián Lara, Laura; Hernàndez Lorente, Eva; García Llopis, Paula

doi:10.1016/j.medcle.2021.03.030

array:24 ["pii" => "S2387020621006938" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.03.030" "estado" => "S300" "fechaPublicacion" => "2022-01-21" "aid" => "5679" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2022;158:94-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775321002438" "issn" => "00257753" "doi" => "10.1016/j.medcli.2021.03.030" "estado" => "S300" "fechaPublicacion" => "2022-01-21" "aid" => "5679" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2022;158:94-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "Carta al Editor" "titulo" => "Bradicardia por remdesivir: estudio de dos casos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "94" "paginaFinal" => "95" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Bradycardia due to remdesivir: Report of two cases" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura Cebrián Lara, Eva Hernàndez Lorente, Paula García Llopis" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "Cebrián Lara" ] 1 => array:2 [ "nombre" => "Eva" "apellidos" => "Hernàndez Lorente" ] 2 => array:2 [ "nombre" => "Paula" "apellidos" => "García Llopis" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020621006938" "doi" => "10.1016/j.medcle.2021.03.030" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006938?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321002438?idApp=UINPBA00004N" "url" => "/00257753/0000015800000002/v1_202201120526/S0025775321002438/v1_202201120526/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2387020621006951" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.03.031" "estado" => "S300" "fechaPublicacion" => "2022-01-21" "aid" => "5671" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2022;158:95-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Refractory juvenile dermatomyositis: Response to tofacitinib" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "95" "paginaFinal" => "96" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatomiositis juvenil refractaria: respuesta al tofacitinib" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1558 "Ancho" => 2500 "Tamanyo" => 203816 ] ] "descripcion" => array:1 [ "en" => "(A) X-ray findings of calcification on the patient's two legs before being treated with tofacitinib, there were a lot of calcifications on both legs. (B) X-ray findings of calcification on the patient's two legs, after 17 months’ treatment with tofacitinib, calcifications regressed. In (A), the white dot image in the figure is calcification as shown by the red arrow. In (B), the calcification as shown by the red arrow has disappeared." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Qingfang Zhou, Ruohang Weng, Yu Xia" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Qingfang" "apellidos" => "Zhou" ] 1 => array:2 [ "nombre" => "Ruohang" "apellidos" => "Weng" ] 2 => array:2 [ "nombre" => "Yu" "apellidos" => "Xia" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0025775321002359" "doi" => "10.1016/j.medcli.2021.03.022" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321002359?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006951?idApp=UINPBA00004N" "url" => "/23870206/0000015800000002/v1_202201220701/S2387020621006951/v1_202201220701/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020621006926" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.03.029" "estado" => "S300" "fechaPublicacion" => "2022-01-21" "aid" => "5621" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2022;158:93-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Vaccines: A universal public good" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "93" "paginaFinal" => "94" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vacunas: un bien público universal" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jaume Padrós Selma" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Jaume" "apellidos" => "Padrós Selma" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775321001470" "doi" => "10.1016/j.medcli.2021.03.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321001470?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006926?idApp=UINPBA00004N" "url" => "/23870206/0000015800000002/v1_202201220701/S2387020621006926/v1_202201220701/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Bradycardia due to remdesivir: Report of two cases" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "94" "paginaFinal" => "95" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Laura Cebrián Lara, Eva Hernàndez Lorente, Paula García Llopis" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "Cebrián Lara" ] 1 => array:2 [ "nombre" => "Eva" "apellidos" => "Hernàndez Lorente" ] 2 => array:4 [ "nombre" => "Paula" "apellidos" => "García Llopis" "email" => array:1 [ 0 => "paulagarciallopis@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Farmacia, Hospital Universitario de La Ribera, Alzira, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bradicardia por remdesivir: estudio de dos casos" ] ] "textoCompleto" => "The current 2019 coronavirus disease (COVID-19) pandemic is posing a global scientific and health challenge in the generation of quality evidence. Very few treatments have proven to be effective, although several options have been proposed.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Remdesivir, a nucleotide analog with in vitro activity against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by inhibiting its ribonucleic acid (RNA) replication, is one of the most widely used and approved treatments for COVID-19 according to its summary of product characteristics. Because data obtained in clinical trials seem to indicate that hospitalized patients requiring low-flow oxygen therapy achieve the best results with this treatment, these are the types of patients in whom this drug’s use is contemplated in the document prepared by the Spanish Health Ministry.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The aim of antiviral treatment with remdesivir is to prevent an increase in the severity of the disease, promote the patients’ clinical recovery, and, thus, indirectly reduce the length of the hospital stay of COVID-19 patients. According to the drug’s summary of product characteristics,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> it is indicated for adults and teenagers with pneumonia secondary to a SARS-CoV-2 infection requiring supplemental oxygen therapy. The dose of remdesivir administered to patients ≥12 years and weighing at least 40 kg is 200 mg as a loading dose on the first day and 100 mg daily as of the second day, both administered through an intravenous infusion. The treatment’s total duration should be at least 5 days and no more than 10 days. The most frequent adverse effects reported are transaminase level elevation, nausea, headache, and skin rash.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>In this paper we present two cases of symptomatic sinus bradycardia secondary to the administration of remdesivir in two patients with SARS-CoV-2 pneumonia.The first patient is a 47-yearold overweight man with no pathological history who was admitted to the hospitalization ward due to presenting with bilateral pneumonia secondary to a SARS-CoV-2 infection. Because his oxygen saturation was 93%, oxygen therapy at a flow of 2 L/min was started, together with intravenous treatment with dexamethasone 6 mg/day, bemiparin 3500 IU/day, paracetamol 1 g/8 h, and inhaled drugs. Because he did not improve with this therapy, treatment with remdesivir was started while maintaining dexamethasone. After receiving the third dose of remdesivir, he developed symptomatic bradycardia with presyncope symptoms, with sinus bradycardia (heart rate of 45 beats/min) being diagnosed. After discontinuing dexamethasone and remdesivir, treatment with intravenous boluses of methylprednisolone 250 mg/day was administered for three days owing to the potential heart involvement of the SARS-CoV-2 infection. Since he continued to exhibit signs of asymptomatic bradycardia (heart rate of 49–50 beats/min), a Holter monitor study was carried out, detecting sinus rhythm readings. The bradycardia gradually resolved within the 72 h following the drug’s withdrawal. He was eventually discharged nine days after his initial admission with an improved and stable condition.The second patient is a 74-year-old hypertensive man who was diagnosed with a non-operable squamous cell lung cancer in May 2020 and treated with chemoradiotherapy with curative intent. On admission, the patient presented with respiratory failure secondary to moderate pneumonia caused by a SARS-CoV-2 infection, owing to which treatment with ceftriaxone 2 g/day, azithromycin 500 mg/day, bemiparin 5000 IU/day, as well as chronic ambulatory medication (losartan 50 mg/day and tamsulosin 0.4 mg/day) was started. As he did not improve, three boluses of intravenous methylprednisolone 125 mg/day and remdesivir at the standard dose were added to his treatment regimen. After receiving the third dose of remdesivir, he developed sinus bradycardia (heart rate of 45 beats/min), owing to which remdesivir and azithromycin were discontinued. The bradycardia resolved within the following 24 h and, once his clinical condition had improved, he was discharged from the hospital two days later.We conducted a search in PubMed using terms “adverse drug reaction” and “remdesivir”, identifying hypotension secondary to the drug’s infusion as a potential adverse reaction described in the available literature,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> in addition to atrial fibrillation.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> However, no cases of bradycardia similar to those reported in this paper have been reported to date. Remdesivir is a drug with few data available on its use and for which the mechanism of action and safety profile have not yet been described in detail.After applying the modified Karch and Lasagna causality algorithm used by the Spanish Pharmacovigilance System for Medicines for Human Use (SEFV-H, Sistema Español de Farmacovigilancia de Medicamentos de Uso Humano), both adverse drug reactions (ADRs) were classified as possible (4 points) and reported through a yellow card notice to the SEFV-H.The pharmacist’s role is crucial in ensuring patient safety, and the notification of adverse effects is a key aspect of pharmacovigilance, particularly when using therapies for which there is limited experience in terms of their management.Knowing both the efficacy and safety profile of the therapies used in the treatment of COVID-19 is an additional challenge for healthcare professionals in relation to which we must always maintain a critical and cautious attitude owing to the avalanche of information to which we are being subjected." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Cebrián Lara L, Hernàndez Lorente E, García Llopis P. Bradicardia por remdesivir: estudio de dos casos. Med Clin (Barc). 2022;158:94–95." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.M. Sanders" 1 => "M.L. Monogue" 2 => "T.M. Jodlowski" 3 => "J.M. Cutrell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2020.6019" "Revista" => array:7 [ "tituloSerie" => "JAMA" "fecha" => "2020" "volumen" => "323" "paginaInicial" => "1824" "paginaFinal" => "1836" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32282022" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S147020451470302X" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Protocolo farmacoclínico del uso de remdesivir (Veklury®) en el tratamiento de la enfermedad por COVID-19 en el Sistema Nacional de Salud. Ministerio de Sanidad. Versión 8/9/2020. Available from: <a target="_blank" href="https://www.mscbs.gob.es/profesionales/farmacia/valtermed/docs/20200908_Protocolo_farmacoclinico_remdesivir2.pdf">https://www.mscbs.gob.es/profesionales/farmacia/valtermed/docs/20200908_Protocolo_farmacoclinico_remdesivir2.pdf</a>. [Accessed 26 January 2021]." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "European Medicines Agency. Veklury: EPAR Product information. Available from: <a target="_blank" href="https://www.ema.europa.eu/en/documents/product-information/veklury-epar-product-information_es.pdf">https://www.ema.europa.eu/en/documents/product-information/veklury-epar-product-information_es.pdf</a>. [Accessed 26 January 2021]." ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reacciones adversas a fármacos utilizados en el tratamiento específico de la infección por SARS-CoV-2" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Herrera-Lasso Regás" 1 => "M.T. Dordal Culla" 2 => "R. Lleonart Bellfill" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin" "fecha" => "2020" "volumen" => "155" "paginaInicial" => "448" "paginaFinal" => "453" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emerging treatments in COVID-19: adverse drug reactions including drug hypersensitivities" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z.R. Manjaly Thomas" 1 => "A. Leuppi-Taegtmeyer" 2 => "D. Jamiolkowski" 3 => "E. Steveling-Klein" 4 => "F. Bellutti-Enders" 5 => "K. Scherer Hofmeier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaci.2020.07.008" "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2020" "volumen" => "146" "paginaInicial" => "786" "paginaFinal" => "789" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32710973" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015800000002/v1_202201220701/S2387020621006938/v1_202201220701/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015800000002/v1_202201220701/S2387020621006938/v1_202201220701/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006938?idApp=UINPBA00004N"]

ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

See more Open Access Option

Indexed in:

Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, SciVerse ScienceDirect

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.6

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.1

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.371

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.511

View more metrics

Journal Information

Previous article | Next article

Vol. 158. Issue 2.

Pages 94-95 (January 2022)

Lee este artículo en Español

Export reference

Download PDF

Article

These are the options to access the full texts of the publication Medicina Clínica (English Edition)

Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”

Subscribe to

Medicina Clínica (English Edition)

More information

Purchase

Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now

Contact

Phone for subscriptions and reporting of errors

From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.

Calls from Spain

932 415 960

Calls from outside Spain

+34 932 415 960

E-mail

atencionalcliente@elsevier.com

Publish in

Medicina Clínica

Tools

Free access articles

Associations of physical activity, sedentary time,...

Med Clin. 2024;163:327-35

Burden of COVID-19 variant omicron in immunocompromised...

Med Clin. 2024;163:347-59

Raynaud phenomenon in a baseball...

Med Clin. 2024;163:e79

Medicina Clínica (English Edition) follows the Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals

Indexed in:

Follow us:

Subscribe:

Article

Subscribe to our newsletter