Metoprolol

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

In a case series of four patients hospitalised and treated for COVID-19 in the USA between March 2020 and April 2020, a 62-year-old man and a 64-year-old man were described; they developed third degree atrioventricular (AV) block during treatment with metoprolol for hypertension [routes, dosages and durations of treatments to reaction onsets not stated].

Patient 2: A 62-year-old man, who had diabetes mellitus, coronary artery disease and hypertension, for which he had been receiving metoprolol, presented to the emergency department with high fever, cough and dyspnoea. He required oxygen supplementation. After subsequent analyses, he was diagnosed with COVID-19. On admission day 1, he had an episode of AV block lasting for 6 hours, which was observed during telemetry and confirmed through 12-lead ECG. The occurrence of AV block was associated with metoprolol. Metoprolol was stopped and temporary cardiac spacing was initiated. Thereafter, he remained haemodynamically stable, and the heart block spontaneously resolved on the following day.

Patient 4: A 64-year-old man, who had hypertension, for which he had been receiving metoprolol, presented to the emergency department with high fever, cough and dyspnoea. He required oxygen supplementation. After subsequent analyses, he was diagnosed with COVID-19. On admission day 2, he had an episode of intermittent AV block lasting for 2-7 minutes, which was observed during telemetry and confirmed through 12-lead ECG. The occurrence of AV block was associated with metoprolol. Metoprolol was immediately discontinued. The bradyarrhythmia spontaneously resolved within 48 hours. Off-label hydroxychloroquine was started for COVID-19, after resolution of the heart block.