1. Safety and effectiveness concerns of lopinavir/ritonavir in COVID-19 affected patients: a retrospective series
- Author
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Marc-Antoine Lepage, Ami M. Grunbaum, Nicholas Rozza, and Richard Kremer
- Subjects
Male ,Time Factors ,viruses ,Human immunodeficiency virus (HIV) ,Lopinavir/ritonavir ,safety profile ,Toxicology ,medicine.disease_cause ,Lopinavir ,0302 clinical medicine ,Risk Factors ,immune system diseases ,030212 general & internal medicine ,Coronavirus ,Aged, 80 and over ,Brief Report ,case series ,virus diseases ,General Medicine ,Middle Aged ,Drug Combinations ,Treatment Outcome ,Host-Pathogen Interactions ,Female ,Patient Safety ,Drug Monitoring ,Hyponatremia ,medicine.drug ,Adult ,Coronavirus disease 2019 (COVID-19) ,Short Communication ,Antiviral Agents ,Risk Assessment ,03 medical and health sciences ,medicine ,Humans ,Aged ,Retrospective Studies ,Ritonavir ,SARS-CoV-2 ,business.industry ,COVID-19 ,030208 emergency & critical care medicine ,Virology ,COVID-19 Drug Treatment ,Drug Overdose ,business - Abstract
Context Originally developed for treatment of human immunodeficiency virus (HIV), the antiviral combination lopinavir/ritonavir (LPV/r) is being repurposed for treating the novel coronavirus disease (COVID-19) despite minimal experience in this markedly different population and an in-vitro derived EC50 against SARS-CoV-2 several hundred-fold greater than for HIV. We present a case series including a case of severe hyponatremia and a 32-fold overdose raising safety and effectiveness concerns in COVID-19 patients. Methods We measured LPV trough concentrations in 12 patients and reviewed their clinical charts for side effects known to occur in HIV patients. Findings Compared to established LPV trough concentrations in HIV patients, concentrations in COVID-19 patients were 3-fold greater (19.37 ± 10.12 mcg/mL versus 6.25 mcg/mL). In addition, cholestasis and dyslipidemia toxicity thresholds were exceeded in 12/12 and 11/12 patients respectively. No patients achieved the presumed therapeutic concentration. Side effects included gastrointestinal symptoms (5/12), electrolyte imbalances (4/12), liver enzyme disturbances (5/12) and triglyceride elevations (2/12). Conclusion No patients reached presumed therapeutic LPV concentrations despite experiencing side effects and exceeding cholestasis and dyslipidemia toxicity thresholds. This raises concerns for the safety and effectiveness of LPV/r. Clinicians should consider closely monitoring for side effects and not necessarily attribute them to COVID-19.
- Published
- 2021