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DRUGS INCREASE RISK FOR SARS-CoV-2 (COVID-19) INFECTION

https://bit.ly/2J1YJW6

The Federal Government officials estimate that between 100,000 and 240,000 people will die from this infection

 

ACE inhibitors, ARBs, IBUPROFEN, THIAZOLIDINEDIONES AND DIABETES MAY CONFER HIGHER RISK FOR SARS-CoV-2 (COVID-19)

Lawrenceville, NJ (Dr Charles Simone) – It is known that coronaviruses (SARS-CoV – severe acute respiratory syndrome coronavirus, and SARS-CoV-2) bind to target cells via angiotensin-converting enzyme 2 (ACE2) [1]. 

COVID-19 coronavirus attaches and binds to their target cells through ACE2 protein sites on cells of the lung, intestine, kidney, and blood vessels [1]. 

ACE2 sites are increased [2] by :

Ibuprofen,

Anti-hypertension medicines like

ACE (angiotensin-converting enzyme) inhibitors

ARBs (angiotensin II type-I receptor blockers),

Thiazolidinediones (used to treat diabetes), and

Having diabetes type 1 and type 2.

The most frequent comorbidities (cerebrovascular diseases, diabetes, hypertension, coronary artery disease) reported so far of patients with COVID-19 are usually treated with angiotensin-converting enzyme (ACE) inhibitors, although this was not indicated in the studies. 

This higher amount of ACE2 will increase infection with COVID-19 and consequently can increase the risk for severe and fatal COVID-19.

Antihypertensive calcium channel blockers do not increase ACE2 and therefore could be an alternate drug. [3].

Speak with your prescribing physician.

Examples of Angiotensin-Converting Enzyme (ACE) inhibitor

  • Benazepril (Lotensin, Lotensin Hct), 

  • Captopril (Capoten),

  • Enalapril (Vasotec),

  • Fosinopril (Monopril),

  • Lisinopril (Prinivil, Zestril),

  • Moexipril (Univasc)

  • Perindopril (Aceon),

  • Quinapril (Accupril),

  • Ramipril (Altace), 

  • Trandolapril (Mavik).

Examples of Angiotensin II Receptor Blockers (ARBs) include:

  • Azilsartan (Edarbi)

  • Candesartan (Atacand)

  • Eprosartan

  • Irbesartan (Avapro)

  • Losartan (Cozaar)

  • Olmesartan (Benicar)

  • Telmisartan (Micardis)

  • Valsartan (Diovan)

Examples of Thiazolidinediones include:

  • Rosiglitazone (Avandia)

  • Pioglitazone (Actos)

Examples of calcium channel blockers include:

  • Norvasc (amlodipine)

  • Plendil (felodipine)

  • DynaCirc (isradipine)

  • Cardene (nicardipine)

  • Procardia XL, Adalat (nifedipine)

  • Cardizem, Dilacor, Tiazac, Diltia XL (diltiazem)

  • Sular (Nisoldipine)

  • Isoptin, Calan, Verelan, Covera-HS (verapamil) 

A joint opinion statement about this topic was issued on March 17, 2020 by the American College Cardiology, American Heart Association, and the Heart Failure Society of America [4]:

“There are no experimental or clinical data demonstrating beneficial or adverse outcomes among COVID-19 patients using ACE inhibitors or ARB medications. …. In the event patients with cardiovascular disease are diagnosed with COVID-19, individualized treatment decisions should be made according to each patient’s hemodynamic status and clinical presentation.” 

 

Dr Simone’s Recommendation March 18, 2020:

Speak with your prescribing physician about this to determine what is best for you. 

We should always decrease risk while maintaining good blood pressure and diabetes control.  Diabetes (34 million Americans) and certain medicines (ACE inhibitors, ARBs, ibuprofen, thiazolidinediones) taken by tens of millions of Americans increase the ACE2 receptors that allow the virus to attach and infect cells. Once these patients are infected, it may be too late.  Therefore, physicians should consider modifying these medications or substituting them with calcium channel blockers or other diabetes medicines to maintain good blood pressure control and blood glucose control for a temporary period of time until the pandemic wanes.

 

[1] Wan Y et al. Receptor recognition by novel coronavirus from Wuhan: An analysis based on decade-long structural studies of SARS. J Virology.2020; (published online Jan 29). DOI:10.1128/JVI.00127-20

[2] Li XC et al. The vasoprotective axes of the renin-angiotensin system: physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases. Pharmacol Res.2017; 12521-38

[3] Fang L, et al. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respiratory Medicine. March 11, 2020. https://doi.org/10.1016/S2213-2600(20)30116-8

[4] https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19

© 2020 Charles B. Simone, M.MS., M.D.