Clinical guidance for navigating the QTc-prolonging and arrhythmogenic potential of pharmacotherapy during the COVID-19 pandemic

Ir J Med Sci. 2021 Feb;190(1):403-409. doi: 10.1007/s11845-020-02291-7. Epub 2020 Jul 6.


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for coronavirus disease 19 (COVID-19), has rapidly spread since December 2019 to become the focus of healthcare systems worldwide. Its highly contagious nature and significant mortality has led to its prioritization as a public health issue. The race to prevent and treat this disease has led to "off-label" prescribing of medications such as hydroxychloroquine, azithromycin, and Kaletra (lopinavir/ritonavir). Currently, there is no robust clinical evidence for the use of these drugs in the treatment of COVID-19, with most, if not all of these medications associated with the potential for QT interval prolongation, torsades de pointes, and resultant drug-induced sudden cardiac death. The aim of this document is to help healthcare providers mitigate the potential deleterious effects of drug-induced QTc prolongation.

Keywords: COVID-19; Drug-induced QTc prolongation; Guidelines; Torsades de pointes.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / adverse effects*
  • Antiviral Agents / adverse effects*
  • Azithromycin / adverse effects*
  • COVID-19 / drug therapy*
  • Drug Combinations
  • Electrocardiography
  • Enzyme Inhibitors / adverse effects
  • Humans
  • Hydroxychloroquine / adverse effects*
  • Long QT Syndrome / blood
  • Long QT Syndrome / chemically induced*
  • Long QT Syndrome / diagnosis
  • Long QT Syndrome / prevention & control
  • Lopinavir / adverse effects*
  • Magnesium / blood
  • Pandemics
  • Potassium / blood
  • Practice Guidelines as Topic
  • Risk Assessment
  • Risk Factors
  • Ritonavir / adverse effects*
  • SARS-CoV-2
  • Torsades de Pointes / chemically induced*


  • Anti-Bacterial Agents
  • Antiviral Agents
  • Drug Combinations
  • Enzyme Inhibitors
  • lopinavir-ritonavir drug combination
  • Lopinavir
  • Hydroxychloroquine
  • Azithromycin
  • Magnesium
  • Ritonavir
  • Potassium

Supplementary concepts

  • COVID-19 drug treatment