ritonavir and Bradycardia

A woman in her 80s was brought to the emergency department for acute onset of generalised weakness, lethargy and altered mental state. The emergency medical service found her to have symptomatic bradycardia, and transcutaneous pacing was done. Medical history was notable for hypertension, hyperlipidaemia, type 2 diabetes, and a recently diagnosed SARS-CoV-2 (COVID-19) infection for which she was prescribed ritonavir-boosted nirmatrelvir (Paxlovid) two days before the presentation. On arrival at the hospital, she was found to have marked bradycardia with widened QRS, hyperglycaemia and metabolic acidosis. Transvenous pacing along with pressor support and insulin were initiated, and she was admitted to the intensive care unit. Drug interaction between ritonavir-boosted nirmatrelvir and verapamil leading to verapamil toxicity was suspected of causing her symptoms, and both drugs were withheld. She reverted to sinus rhythm on the fourth day, and the pacemaker was discontinued.

Topics: Bradycardia; COVID-19; COVID-19 Drug Treatment; Diabetes Mellitus, Type 2; Female; Humans; Hypertension; Ritonavir; SARS-CoV-2; Verapamil

Topics: Aged; Antiviral Agents; Bradycardia; Comorbidity; Coronary Disease; COVID-19 Drug Treatment; Drug Combinations; Humans; Hypertension; Lopinavir; Male; Ritonavir

Topics: Age Factors; Aged; Aged, 80 and over; Antiviral Agents; Betacoronavirus; Bradycardia; Coronavirus Infections; COVID-19; COVID-19 Drug Treatment; Drug Combinations; Female; Heart Rate; Humans; Intensive Care Units; Lopinavir; Male; Middle Aged; Pandemics; Pneumonia, Viral; Prospective Studies; Risk Assessment; Risk Factors; Ritonavir; SARS-CoV-2; Time Factors; Treatment Outcome

Topics: Acquired Immunodeficiency Syndrome; Adult; Bradycardia; Darunavir; Female; HIV Protease Inhibitors; Humans; Ritonavir

Topics: Anti-HIV Agents; Atazanavir Sulfate; Benzazepines; Bradycardia; Cytochrome P-450 CYP3A Inhibitors; Drug Interactions; Emtricitabine; Female; Heart Failure; HIV Infections; Humans; Ivabradine; Middle Aged; Ritonavir; Tenofovir

Topics: Bradycardia; Drug Interactions; Drug Therapy, Combination; HIV Infections; HIV Protease Inhibitors; Humans; Lopinavir; Male; Middle Aged; Post-Exposure Prophylaxis; Pyrimidinones; Ritonavir

Topics: Acquired Immunodeficiency Syndrome; Anti-HIV Agents; Bradycardia; Drug Combinations; Dyspnea; Electrocardiography; Female; HIV Protease Inhibitors; Humans; Lopinavir; Middle Aged; Pyrimidinones; Ritonavir; Syndrome; Tachycardia

We describe 2 patients with acquired immunodeficiency syndrome who had potentially fatal bradyarrhythmia that occurred shortly after commencement of antiretroviral therapy. Lopinavir-ritonavir was the only drug that both patients were using.

Topics: Acquired Immunodeficiency Syndrome; Adult; Anti-HIV Agents; Bradycardia; Humans; Lopinavir; Male; Middle Aged; Pyrimidinones; Ritonavir