LETTER TO THE EDITOR Year : 2020  |  Volume : 52  |  Issue : 6  |  Page : 533-534  

Antiviral effect of amiodarone and its possible role in COVID-19: An appraisal

Snehal Lonare1, Mythili Hazarika2, Chandra Kr Das3
1 Department of Pharmacology and Toxicology, GADVASU, Ludhiana, Punjab, India
2 Department of Psychiatry, Guwahati Medical College Hospital, Affiliated to Srimanta Sankaradeva University of Health Sciences, Assam, India
3 Associate Professor of Clinical Psychology, Gauhati Medical College and Hospital Affiliated to Srimanta Sankaradeva University of Health Sciences, Assam, India

Date of Submission28-Jul-2020Date of Decision05-Aug-2020Date of Acceptance04-Jan-2021Date of Web Publication19-Feb-2021

Correspondence Address:
Dr. Chandra Kr Das
Hayat Hospital, Lalganesh, Guwahati - 781 034, Assam
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/ijp.IJP_714_20

How to cite this article:
Lonare S, Hazarika M, Das CK. Antiviral effect of amiodarone and its possible role in COVID-19: An appraisal. Indian J Pharmacol 2020;52:533-4

SARS-CoV-2 acts on respiratory and cardiovascular system through ACE-2 receptor, and it is hypothesized that it downregulates ACE-2 receptor causing increased activity of angiotensin II, leading to effects such as hypertension, thrombosis, increased inflammation, and cytokine storm predisposing to increased risks of arrhythmias.[1]

Cardiac injury is reported among patients of COVID-19. COVID-19 is reported to cause acute cardiac injury and myocarditis.[2] Relationship between COVID-19 infection and arrhythmias is still not clear and is under evaluation. A report of 138 patients described arrhythmia in 16.7% which increased in prevalence to 44.4% with severe disease who were admitted to the intensive care unit.[3]

Class-II antiarrhythmic drug amiodarone is one of the most effective drugs for the treatment of atrial and ventricular arrhythmias.[4] Well known for its proarrhythmic effects,[5] it is also a mild coronary vasodilator and antianginal agent.[6]

Coming to antiviral effect, amiodarone is reported to inhibit Ebola virus infection in in vitro settings and in human macrophages,[7] which was later confirmed in mouse model studies. However, human studies failed to demonstrate significant effect.[7] Amiodarone has also been reported to inhibit hepatitis C virus infection in vitro.[8]

In in vitro settings, amiodarone inhibited SARS-CoV in a concentration-dependent manner. The drug accumulates in endosome and lysosome and thus act at postendosomal level and the distribution is concentration dependent.[9] At low concentrations, amiodarone accumulates in lysosomes, and at higher concentrations, they accumulate into endosomes.[9] Although we do not have direct clinical data of amiodarone use against COVID-19, two studies are registered in clinicaltrials.gov and are under process of recruitment (N9CT04278404; NCT04351763). A case study is also reported about the safety and efficacy of amiodarone in improving life in COVID-19 patient.[10] Amiodarone warrants in vitro studies against COVID-19. Thus, amiodarone has the possibility to act not only as a possible antiviral agent against COVID-19 but also as an antiarrhythmic agent and thus may confer dual benefit. However, critical risk benefit is warranted.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Wang K, Gheblawi M, Oudit GY. Angiotensin converting enzyme 2: A double-edged sword. Circulation 2020;142:426-8.  
    2.Akhmerov A, Marbán E. COVID-19 and the heart. Circ Res 2020;126:1443-55.  
    3.Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9.  
    4.Hrudikova Vyskocilova E, Grundmann M, Duricova J, Kacirova I. Therapeutic monitoring of amiodarone: Pharmacokinetics and evaluation of the relationship between effect and dose/concentration. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017;161:134-43.  
    5.Haverkamp W, Israel C, Parwani A. Klinische Besonderheiten der Therapie mit Amiodaron.Herzschrittmachertherapie Elektrophysiologie 2017;28:307-16.  
    6.Google Books. Cardiac Therapy. Available from: https://books.google.co.in/books?id=s6rSBwAAQBAJ&pg=PA232&lpg=PA232&dq=Charlier,+R.,+Deltour,+G.,+Tondeur,+T.,+et+al.:+Recherches+dans+la+serie+des+benzofurannes.+Arch.+Int.+Pharmacodyn.,+139:255-264,+1962&source=bl&ots=_2t3K1Wj70&sig=ACfU3U114JIhHmpgJPU7×IAW7W10WfuVpg&hl=en&sa=X&ved=2ahUKEwjqsIL6w-L9pAhWU4XMBHZN2DKQQ6AEwAHoECAoQAQ#v=onepage&q=Charlier%2C%20R.%2C%20Deltour%2C%20G.%2C%20Tondeur%29C%20T.%2C%20et%20al.%3A%20Recherches%20dans%20la%20serie%20des%20benzofurannes.%20Arch.%20Int.%20Pharmacodyn.%2C%20139%3A255-264%2C%201962&f=false9. [Last accessed on 2020 Jun 02].  
    7.Dyall J, Johnson JC, Hart BJ, Postnikova E, Cong Y, Zhou H, et al. In vitro and in vivo activity of amiodarone against Ebola virus. J Infect Dis 2018;218:S592-S596.  
    8.Cheng YL, Lan KH, Lee WP, Tseng SH, Hung LR, Lin HC, et al. Amiodarone inhibits the entry and assembly steps of hepatitis C virus life cycle. Clin Sci (Lond) 2013;125:439-48.  
    9.Stadler K, Ha HR, Ciminale V, Spirli C, Saletti G, Schiavon M, et al. Amiodarone alters late endosomes and inhibits SARS coronavirus infection at a post-endosomal level. Am J Respir Cell Mol Biol 2008;39:142-9.  
    10.Castaldo N, Aimo A, Castiglione V, Padalino C, Emdin M, Tascini C. Safety and efficacy of amiodarone in a patient with COVID-19. JACC Case Rep 2020;2:1307-10.