Does Remdesivir (Remdesivir) cause chest pain?

Remdesivir and Chest Pain: Evidence Assessment

Remdesivir has not been specifically associated with chest pain as a common adverse effect, but it can cause cardiac complications including bradycardia and other cardiovascular effects that might manifest as chest discomfort. 1, 2

Documented Adverse Effects of Remdesivir

Cardiovascular Effects

• Cardiac events: Analysis of the European Spontaneous Adverse Event Reporting System showed that 8.4% of adverse events related to remdesivir were cardiac events 1
• Bradycardia:
  • 49% of patients receiving remdesivir experienced bradycardia within 5 days of administration 3
  • Even young, healthy patients without pre-existing heart conditions can develop marked sinus bradycardia during remdesivir therapy 4
  • Mean time to cardiac events was 3.3 days (±2.2) after administration 1

Potential Mechanisms for Cardiovascular Effects

• Remdesivir is a 1'-cyano-substituted adenosine nucleotide prodrug that may have adenosine-like effects 2
• It can potentially:
  • Cause vasodilation leading to hypotension
  • Affect cardiac action potentials
  • Induce cytotoxic effects in cardiomyocytes
  • Bind to human mitochondrial RNA polymerase
  • Alter field potential duration with decreased Na+ peak amplitudes 2

Other Common Adverse Effects

• Hepatic effects: Most frequently reported adverse events (19.4%) 1
  • Elevated liver enzymes were commonly reported in multiple studies 5
  • Monitoring of liver function is required before and during treatment 6
• Renal effects: 11.1% of adverse events involved renal and urinary disorders 1
• Gastrointestinal symptoms: Including nausea, vomiting, and gastroparesis 5
• Rash: Maculopapular rash has been reported 5

Clinical Implications

Risk Assessment

• Patients with pre-existing cardiovascular disease may be at higher risk for cardiac complications 2
• Male sex and hyperlipidemia were significant predictors of inpatient mortality in patients who developed bradycardia after remdesivir treatment 3

Monitoring Recommendations

• All patients receiving remdesivir should have cardiac monitoring, even those without pre-existing heart conditions 4
• Particular vigilance is needed within the first 5 days of administration, when most cardiac events occur 1

Potential Long-Term Effects

• Interestingly, intravenous remdesivir administration during acute COVID-19 may have a protective effect against developing post-COVID-19 pain, including chest pain 7
  • Specifically showed protective effect for thorax/chest pain (OR 0.277,95% CI 0.100-0.766) 7

Clinical Decision Making

When considering remdesivir therapy:

1. Assess baseline cardiovascular risk

   • Pre-existing heart conditions
   • Hyperlipidemia
   • Male sex (potentially higher risk)

2. Monitor during treatment

   • Heart rate and rhythm
   • Blood pressure
   • Liver function tests (twice weekly in high-risk patients) 6
   • Renal function

3. Consider treatment duration

   • Shorter treatment courses (5 days vs. 10 days) may minimize risks 6
   • No significant mortality difference between 5-day and 10-day courses in most patients 5

4. Watch for warning signs

   • Bradycardia
   • Hypotension
   • Chest discomfort or pain
   • Abnormal ECG findings

While chest pain is not explicitly listed among the most common adverse effects of remdesivir in the available evidence, the documented cardiac effects could potentially manifest as chest discomfort in some patients. Clinicians should maintain vigilance for all potential cardiac manifestations during remdesivir administration.