Immunosuppressant Drugs |
Associated Risks with
COVID-19 |
Adverse Reactions |
Drug-Drug
Interactions |
Etanercept |
Infectious complications in patients suffering with
rheumatoid and immune diseases. Follow CDC guidelines and continue
immunosuppressive medications unless infection present [11] |
It can
cause adverse reactions in patients suffering from Psoriatic Arthritis,
Ankylosing Spondylitis, Rheumatoid Arthritis, Plaque Psoriasis etc
[13]. |
Drug-drug interactions with Anakinra (a drug for rheumatoid
arthritis) leading to serious infection. Not recommended with
Cyclophosphamide in Wegener’s Granulomatosis patients as it can lead to
non-cutaneous solid malignancies [13] |
Mycophenolate Mofetil |
Oversuppression of the immune system can give
rise to infections and make immunocompromised and transplant patients
susceptible to COVID-19 with complications. It is advised to continue
the medications as the benefits outweigh the risk [18-19] |
It can
cause development of lymphoma or lymphoproliferative disease in renal,
cardiac and hepatic transplant patients. It can also lead to fatal
progressive multifocal leukoencephalopathy (PML) [15] |
Drug-Drug
interactions can reduce concentration of Mycophenolate Mofetil with
antacids containing aluminium and magnesium hydroxide (Maalox TC). It
should not be used with live attenuated vaccines as it may be less
effective [15, 17] |
Sirolimus |
Patients taking immunosuppressant drugs are more susceptible
to COVID-19 specifically those suffering from underlying lung disease.
It also reduces lung function (FEV1: forced expiratory volume) [22] |
It can cause adverse reactions in renal transplant by causing
peripheral edema, hypertension, creatinine increase, urinary tract
infection, hypertriglyceridemia etc. It causes stomatitis, abdominal
pain, nasopharyngitis in patients suffering with
Lymphangioleiomyomatosis (LAM - growth of smooth muscle cells in lungs,
lymphatics, pulmonary vessels etc [20. 23]. |
Drug-Drug Interactions
can occur with CYP3A4 inhibitors. Drugs like cimetidine, diltiazem,
fluconazole, protease inhibitor like HIV, hepatitis C etc. can increase
Sirolimus blood concentration. Phenytoin, rifapentine, carbamazepine,
rifapentine decreases Sirolimus blood concentration
[23] |
Cyclosporine |
COVID-19 in-vitro studies show inhibition of the
replication of the coronaviruses as cyclosporine shows antiviral
activity against a variety of RNA viruses. It also shows activity
against betacoronavirus [26-27]. |
It can cause adverse reactions
for liver, kidney and heart transplanted patients leading to renal
dysfunction, tremor, hirsutism, hypertension etc. It can also lead to
glomerular capillary thrombosis with Cyclosporine and cause graft
failure. Cyclosporine can also cause hypomagnesemia leading to
convulsions etc [24, 28]. |
Drug-drug interactions between
Cyclosporine and herbal dietary supplement, St.John’s Wort can cause
rejection of transplanted organs, graft loss and reduction of
cyclosporine in blood concentration. NSAID drugs like naproxen and
sulindac with Cyclosporine can decrease renal function [24,
28] |
Rituximab |
It can deplete lymphocytes leading to serious complications
associated with COVID-19. It can also lead to patient’s susceptibility
to SARS nCoV-2 leading to complication of symptoms like respiratory
failure [31 - 32] |
It can cause adverse reactions leading to
lymphoid malignancies along with lymphopenia, fever, infection, asthenia
(physical weakness) etc. Also, it can cause muscle spasms, nausea,
diarrhea, peripheral edema, anemia in patients suffering with Wegener’s
Granulomatosis disease [29, 33] |
Drug-Drug interactions noted with
cisplatin leading to fatal renal toxicity. It can also cause tumor lysis
syndrome especially in patients suffering with non-hodgkin lymphoma. It
can also cause rise in serum creatinine or lead to oliguria etc [29,
34]. |