Table 2.

Mechanisms, cardiovascular adverse effects, advantages and disadvantages of several medications used in SARS-CoV-2 infection.

Medication	MOA	Effect on SARS-CoV-2	CV toxicity	Advantages	Disadvantages	Ref
Remdesivir	RDRP inhibitor	Reduces symptoms in SARS-CoV-2 patients, inhibits SARS-CoV-2 infection in vitro	Unknown	Established safety profile, resistant to nsp14-ExoN	Causes viral resistance, and must be injected	[17], [77]
Chloroquine/Hydroxychloroquine	Raises endosomal pH and anti-inflammation	Blocks SARS-CoV-2 from early endosomes to endolysosomes, blocks glycosylation of ACE2	Myocardial toxicity, QT prolongation, altered cardiac conductivity	High oral bioavailability, concentrates in lungs	concentrates in the liver, spleen and kidney and efficacy has been debated	[17], [79], [80]
Nitazoxanide	Blocks pyruvate ferredoxin oxidoreductase in anaerobes	Inhibits growth of SARS-CoV-2 and cytokine production from PMNs and IL-6 production	Unknown	parent drug and metabolite are active, can be given orally	Expensive, and safety profile is less understood	[17]
Lopinavir/Ritonavir	Protease inhibitor/CYP450 inhibitor	Shortens median hospital stay in SARS-CoV-2 infected patients	QT interval prolongation, and high degree atrioventricular block	Well studied, oral route	Does not reduce SARS-CoV-2 mortality in recent studies	[78], [84]
Ribavirin	RDRP inhibitor	Inhibits in vitro growth of SARS-CoV-2 at high concentrations	Unknown	Low cost and well-studied	worsens in some patients outcomes and efficacy is debated	[17], [76]
Convalescent plasma	Performs neutralizing immunoglobulin targeting SARS-CoV-2	Lowers viral load and lead to quick improvement of symptoms in critically ill COVID-19 patients	Unknown	Immunomodulatory effects: potentially mitigate cytokine storm	Ineffective in MERS-CoV prophylaxis and must be injected	[87]
Corticosteroids	Reduces inflammatory mediators	combat the damage from cytokine storm, reducing lung injury	Immunosuppression, cardiovascular and metabolic disorders	Useful in later stages of infection	Must be injected, raises mortality and adverse effect risk if used inappropriately	[5], [78]
Ammonium chloride	Raises endosomal pH	Blocks glycosylation of ACE2 receptors and inhibited viral growth in vitro	Ammonia toxicity can lead to bradyarrhythmia	Cheap, few apparent drug interactions	Not well studied and uncommonly used in humans	[17]
ACEI/ARB	Reduces Ang II effect and prevents vasoconstriction	Upregulates ACE2 and prevents overproduction of Ang II, reduces cardiac and lung injury	Hypotension	Well studied, low side effect profile, cheap	not directly target virus and ACE2 upregulation provides virus with more sites to attack	[53]
Tocilizumab	Inhibits IL-6 receptor	combat the damage from cytokine storm	Hypertension, and increased serumcholesterol	Inhibit IL-6 and mitigate cytokine storm	Expensive and does not target SARS-CoV-2	[30]