Hantavirus Cardiopulmonary Syndrome (HCPS) Medication

Updated: Jun 04, 2019
  • Author: Sally Lynne Westcott, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Medication

Medication Summary

Currently, no Food and Drug Administration-approved antiviral drugs, vaccines, or immunotherapeutic agents are available for Hantavirus cardiopulmonary syndrome (HCPS). Although ribavirin, a nucleoside analogue, has shown a statistically significant 7-fold reduction in mortality when initiated early in the treatment of hemorrhagic fever with renal syndrome (HFRS), [63] there is limited data regarding its use for HCPS. One double-blind, placebo-controlled study and one nonrandomized trial showed no survival benefit of ribavirin in the treatment of HCPS, [64, 65] though questions remain regarding study design and lack of power. A meta-analysis of ribavirin in human and animal subjects showed no mortality benefit in humans with HCPS, although the animal studies did show a statistically significant increase in survival. The analysis was hindered by the small number of available studies. [66] As of now, no evidence exists to support an off-label use of ribavirin in the treatment of HCPS.

Based on a study involving 60 Chilean patients with HCPS, glucocorticoids are not recommended as treatment for HCPS. [67]

Some indirect evidence supports the use of neutralizing antibodies, or passive immunotherapy, for HCPS. Bharadwaj et al found that patients who had higher titers of neutralizing antibodies suffered milder disease. [61] Studies addressing the role of passive immunotherapy for treatment or postexposure prophylaxis of HCPS have not yet been published.

Liberal employment of high-dose vasopressors and inotropes, as well as standard administration of antibiotics, is strongly encouraged. (See Emergency Department Care.)

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Inotropes

Class Summary

Used in the implementation of hemodynamic support.

Dopamine (Intropin)

Stimulates beta1- and alpha1-adrenergic and dopaminergic receptors in a dose-dependent fashion; stimulates release of norepinephrine. Lower doses (2-5 mcg/kg/min) mainly stimulate dopamine receptors, producing renal and mesenteric vasodilation. Doses between 5 and 10 mcg/kg/min predominantly stimulate beta1-receptors, causing increased chronotropy, inotropy, and cardiac output. Doses >10 mcg/kg/min stimulate alpha1-receptors, causing marked vasoconstriction. After initiating therapy, dose may be increased by 1-4 mcg/kg/min q5min until optimal response.

Dobutamine (Dobutrex)

Stimulates alpha1-, beta1-, and beta 2-adrenergic receptors; has potent inotropic effects with minimal chronotropic effect; causes vasodilation; is vasopressor of choice in HCPS.

Norepinephrine (Levophed)

Stimulates alpha1- and beta 1-adrenergic receptors; increases inotropy and chronotropy; is potent vasoconstrictor.

Epinephrine (Adrenalin, EpiPen)

Stimulates alpha1-, alpha2-, beta1-, and beta2-adrenergic receptors, increasing cardiac muscle contractility and heart rate as well as vasoconstriction. As a result, increases systemic BP and coronary blood flow.

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Antivirals

Class Summary

These agents inhibit or reduce severity of some viral infections but have no demonstrable effect in HCPS as of yet.

Ribavirin (Virazole)

Proven effective in HFRS caused by Old World Hantaviruses; no demonstrated benefit in HCPS.

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