Azithromycin May Increase Risk for Cardiac Events: Study

Potential COVID-19 medication azithromycin may increase the risk of heart problems. Risks is more if the drug is taken with other commonly prescribed medications.

Azithromycin, the commonly used antibiotic, may not increase the risk of cardiac events, but if taken along with other medications, the risk of cardiac events is increased, according to the team of researchers from the University of Illinois Chicago. Their findings are published JAMA Network Open.

"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.

‘Among patients taking both a QT-prolonging medication and azithromycin together, the risk of cardiac events was significantly higher.’
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"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."

QT-prolonging 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. 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.

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"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."

Source-Eurekalert