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 Table of Contents    
Year : 2020  |  Volume : 52  |  Issue : 6  |  Page : 533-534

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

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

Correspondence Address:
Dr. Chandra Kr Das
Hayat Hospital, Lalganesh, Guwahati - 781 034, Assam
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijp.IJP_714_20

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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

How to cite this URL:
Lonare S, Hazarika M, Das CK. Antiviral effect of amiodarone and its possible role in COVID-19: An appraisal. Indian J Pharmacol [serial online] 2020 [cited 2023 May 30];52:533-4. Available from: https://www.ijp-online.com/text.asp?2020/52/6/533/309735

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.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Wang K, Gheblawi M, Oudit GY. Angiotensin converting enzyme 2: A double-edged sword. Circulation 2020;142:426-8.  Back to cited text no. 1
Akhmerov A, Marbán E. COVID-19 and the heart. Circ Res 2020;126:1443-55.  Back to cited text no. 2
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.  Back to cited text no. 3
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.  Back to cited text no. 4
Haverkamp W, Israel C, Parwani A. Klinische Besonderheiten der Therapie mit Amiodaron.Herzschrittmachertherapie Elektrophysiologie 2017;28:307-16.  Back to cited text no. 5
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.  Back to cited text no. 7
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.  Back to cited text no. 8
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.  Back to cited text no. 9
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.  Back to cited text no. 10


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