Nikhil Prasad Fact checked by:Thailand Medical News Team Apr 06, 2026 1 hour, 59 minutes ago
Medical News: A detailed new study has shed light on a critical yet often overlooked issue during the COVID-19 pandemic—the significant cardiovascular dangers linked to complex drug regimens used in intensive care units (ICUs). The findings suggest that while clinicians were focused on saving lives, certain combinations of medications may have unintentionally increased the risk of fatal heart complications.
Common ICU drug combinations during COVID-19 may have silently triggered dangerous heart complications
High-Risk Prescriptions Were Widespread
The research, accessible here, examined 106 ICU patients treated for COVID-19 in Brasília, Brazil, during 2020. These patients were critically ill, often elderly, and had multiple underlying conditions such as hypertension, diabetes, and obesity.
Due to the severity of illness, patients were given numerous medications simultaneously—a practice known as polypharmacy. However, this created a dangerous environment where drug interactions could amplify harmful side effects. The study found that an overwhelming 96 percent of prescriptions placed patients in a high-risk category for cardiovascular adverse drug events before any intervention.
The Most Dangerous Cardiac Effects Identified
Researchers focused on three key cardiovascular complications:
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QT interval prolongation, a disruption in the heart’s electrical cycle that can lead to arrhythmias
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Torsades de Pointes, a rare but potentially fatal ventricular tachycardia
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Serotonin syndrome, which can affect heart rhythm alongside neurological symptoms
Out of 220 different drugs administered during hospitalization, 67 (around 30 percent) were linked to serious cardiovascular adverse effects. Specifically, 37 drugs were associated with QT prolongation, 21 with Torsades de Pointes, and 9 with serotonin syndrome.
Key Drugs Implicated in Cardiovascular Risks
The study provides critical insight into specific medications and drug classes that contributed to these risks:
1. Opioid Analgesics
Methadone and tramadol were strongly associated with QT interval prolongation and increased risk of Torsades de Pointes.These drugs are commonly used for pain control but can interfere with cardiac electrical activity.
2. Antidepressants and Antipsychotics
Drugs such as amitriptyline, nortriptyline, haloperidol, risperidone, and promethazine were frequently implicated. These medications are often used to manage anxiety, agitation, or delirium in ICU patients but carry known cardiac risks, especially when combined.
3. Antiemetics (Anti-Nausea Drugs)
Ondansetron and domperidone were widely used but linked to QT prolongation.
These drugs are commonly prescribed to prevent nausea caused by other medications.
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4. Antibiotics and Anti-Infectives
Azithromycin and moxifloxacin were identified as contributors to cardiac risk.
These drugs were frequently used during the pandemic despite known cardiac side effects.
5. Antimalarials and Experimental COVID-19 Treatments
Hydroxychloroquine and chloroquine, widely used early in the pandemic, were strongly associated with QT prolongation.
Lopinavir/ritonavir (anti-HIV antivirals) were also used but showed no proven benefit and added to risk burden.
6. Other High-Risk Medications
-Cyclobenzaprine (muscle relaxant)
-Tacrolimus (immunosuppressant)
-Certain psychiatric medications like escitalopram and sertraline
Many patients were exposed to multiple such drugs simultaneously, significantly increasing the likelihood of dangerous interactions.
The Role of Drug Interactions and Synergy
One of the most important findings was that risk was not just linked to individual drugs, but to combinations. When two or more medications that prolong the QT interval were used together, the danger increased dramatically.
Additionally, factors such as low potassium levels, older age, and pre-existing heart conditions further amplified the risk. These variables were measured using the Tisdale score, a clinical tool used to estimate the likelihood of drug-induced heart rhythm problems.
Technology-Driven Intervention Reduced Risk
Researchers used a specialized clinical decision-support system called MedUTI to simulate safer prescribing strategies. By replacing or discontinuing high-risk drugs, they observed:
-A 53 percent reduction in high-risk patients
-A shift of 56 percent of patients into lower-risk categories
-A drop in total serious cardiovascular events, including fewer cases of QT prolongation and Torsades de Pointes
Safer Alternatives Identified
The study outlined several safer substitutions:
-Replacing methadone and tramadol with morphine, fentanyl, or hydromorphone
-Switching antipsychotics and antidepressants to sedatives like propofol, benzodiazepines, or dexmedetomidine
-Substituting ondansetron with metoclopramide
-Eliminating ineffective drugs such as hydroxychloroquine and lopinavir/ritonavir
These adjustments maintained clinical effectiveness while significantly lowering cardiovascular risk.
Patient Characteristics and Risk Factors
The study also highlighted patterns among high-risk patients:
-Older patients had significantly higher risk scores
-Men showed a higher likelihood of increased cardiovascular risk
-Obesity and multiple comorbidities further elevated risk
-Long ICU stays increased exposure to dangerous drug combinations
Conclusion
This
Medical News report underscores a crucial lesson from the COVID-19 pandemic: while aggressive treatment is often necessary in critical care, it must be balanced with careful evaluation of drug interactions and side effects. The findings reveal that a large proportion of ICU patients were exposed to preventable cardiovascular risks due to overlapping medications.
Importantly, the study demonstrates that relatively simple changes—guided by technology and evidence-based decision-making—can dramatically reduce these dangers. Moving forward, integrating clinical decision-support systems into ICU workflows could play a vital role in improving patient safety, reducing mortality, and optimizing treatment outcomes in both pandemic and non-pandemic settings.
The study findings were published in the peer reviewed journal: PLOS One.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0345280
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Read Also:
https://www.thailandmedical.news/articles/coronavirus
https://www.thailandmedical.news/articles/covid19-drugs
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