What are the potential contraindications for a COVID-19 patient taking Lipitor (Atorvastatin), Lasix (Furosemide), Ebivolol (Nebivolol), citrulline, Eliquis (Apixaban), and trazodone?

Managing Medications in a 94-Year-Old COVID-19 Patient

For a 94-year-old COVID-19 positive patient taking Lipitor (atorvastatin), Lasix (furosemide), Ebivolol (nebivolol), citrulline, Eliquis (apixaban), and trazodone, continue all medications with careful monitoring, as there are no absolute contraindications requiring immediate discontinuation. 1

Anticoagulation Management (Eliquis/Apixaban)

• Continue Eliquis (apixaban) as it plays a critical role in preventing thrombotic complications, which are increased in COVID-19 patients
• For hospitalized patients with COVID-19 who are already on oral anticoagulation for atrial fibrillation:
  • If the patient remains stable and can take oral medications, continue Eliquis 1
  • If the patient deteriorates or cannot take oral medications, consider switching to therapeutic-dose LMWH or UFH 1
• Monitor for potential increased thrombotic risk despite anticoagulation, as COVID-19 has been associated with breakthrough thrombotic events even in patients on DOACs 2

Beta-Blocker Management (Ebivolol/Nebivolol)

• Continue Ebivolol unless the patient develops:
  • Severe bradycardia
  • Heart block greater than first degree
  • Cardiogenic shock
  • Decompensated cardiac failure 3
• Monitor heart rate and blood pressure closely, as COVID-19 can cause cardiovascular complications
• Be vigilant for signs of decompensated heart failure which would contraindicate continued use of nebivolol 3

Diuretic Management (Lasix/Furosemide)

• Continue Lasix unless the patient develops anuria 4
• Monitor fluid status, electrolytes (particularly potassium), and renal function
• Adjust dosage based on clinical response and laboratory parameters
• Be alert for dehydration which may worsen renal function in the setting of COVID-19

Statin Management (Lipitor/Atorvastatin)

• Continue Lipitor as there are no specific contraindications with COVID-19 5
• Statins may have potential beneficial effects in COVID-19 due to their pleiotropic and anti-inflammatory properties
• Monitor liver function tests as COVID-19 can cause liver injury

Antiplatelet and Other Medication Considerations

• If the patient is also on antiplatelet therapy, individualize the decision to continue based on thrombotic vs. bleeding risk 1, 6
• For trazodone and citrulline, there are no specific contraindications with COVID-19
• Monitor for potential drug-drug interactions, particularly with any COVID-19 specific treatments that might be initiated

Monitoring Recommendations

• Check renal function and electrolytes regularly (every 24-48 hours if hospitalized)
• Monitor liver function tests
• Check complete blood count with platelets
• Monitor oxygen saturation and respiratory status closely
• Be vigilant for signs of thrombosis despite anticoagulation

Special Considerations for Elderly Patients

• Elderly patients are at higher risk for adverse outcomes from COVID-19
• The risk-benefit ratio for continuing medications should consider the patient's overall condition and prognosis
• Polypharmacy concerns are important but discontinuing chronic medications during acute illness may lead to decompensation of underlying conditions
• Adjust medication doses based on renal function, which may worsen with COVID-19

Remember that while there are no absolute contraindications to the current medication regimen, close monitoring is essential as the patient's clinical status may change rapidly with COVID-19 infection, particularly given the patient's advanced age.