Adverse drug reactions and drug interactions in the treatment of hospitalized patients with coronavirus disease 2019 (COVID-19)

Tatiana A Marins; Alexandre R Marra; Michael B Edmond; Ligia Regina Prystaj Colombo; Sthephanie Favalli Vieira; Fernanda de Oliveira Xavier; Alessandra Gomes Chauvin; João Renato Rebello Pinho; Silvana M de Almeida; Marcelino Souza Durão Junior

doi:10.1017/ash.2021.196

Adverse drug reactions and drug interactions in the treatment of hospitalized patients with coronavirus disease 2019 (COVID-19)

Antimicrob Steward Healthc Epidemiol. 2021 Oct 28;1(1):e38. doi: 10.1017/ash.2021.196. eCollection 2021.

Affiliations

¹ Department of Clinical Pharmacy, Hospital Israelita Albert Einstein, São Paulo, Brazil.
² Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil.
³ Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States.
⁴ West Virginia University School of Medicine, Morgantown, West Virginia, United States.
⁵ Special Techniques Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁶ Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil.

Abstract

Objectives: To identify drugs that were administered off label to hospitalized patients with suspected coronavirus disease 2019 (COVID-19) and to identify adverse drug reactions (ADRs) and drug-drug interactions associated with these therapies.

Methods: This case-control study was conducted in a Brazilian hospital from March to April 2020 among patients with suspected COVID-19, comparing those with positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction (RT-PCR) results and those with negative results.

Results: The most commonly used medications in both groups were azithromycin and hydroxychloroquine. There was a significantly higher prevalence of reactions among patients with positive RT-PCR for SARS-CoV-2 (48.5% vs 28.8%; P = .008) in the propensity score-matched cohort, and the most commonly reported ADRs among these patients were diarrhea (43.8%), elevated liver enzymes (31.3%), and nausea and vomiting (29.7%).

Conclusions: Our data demonstrate that ADRs and drug-drug interactions are common with off-label treatments for COVID-19.

Keywords: COVID-19; adverse drug reactions; drug interactions; off-label.