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Response to the emerging novel coronavirus outbreak(ARB/losartan)

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  • Response to the emerging novel coronavirus outbreak(ARB/losartan)

    Potential use of ARBs, at least losartan, to ameliorate coronavirus. I'm taking 240mg of Telmisartan daily for BP as well as the PPAR-δ effects but may swap to losartan til this passes.

    Of course losartan lacks the PPAR activity but that's only a potential method of metabolic improvement anyway, not funded enough to get accurate enough VO2, VT, etc tests to know for sure.

    What's everyone else's take on this?

    Disclaimer: I am not in the US and can purchase this medicine over the counter, aside from reading labs or imaging a doctor has not prescribed nor advised this dosage and I'm not breaking local "Rx/controlled substance laws". I do not advise doing any of this, this discussion is theoretical only unless you want to bring it up with your doctor.

  • #2
    I take ramipril, and while it might help a bit I wouldn't advise people to take ramipril or an ARB just to try to ward off the COVID-19 virus.


    • #3
      Ramipril is an ACEi though isn't it? I can't picture it doing anything to block a virus using the receptor.


    • #4
      Slightly off topic, but here is a good website, particularly since it's from our government !


      • #5
        Quanticus I just stocked up on standard flu supplies and antipyretic suppositories and metamizol injectable in case myself, the wife or daughter can't keep meds down.

        Sadly I could go to the US and be treated, I've got Tricare, but my wife and daughter don't have their visas yet and I'm not leaving them here alone if we all get sick. I'm really not expecting anything major though, tbh


      • #6
        sthubbar Mexico, right on the US border and regularly cross into the US near Yuma, AZ.


        • #7
          Here is an interesting article on the hypertension aspects of the COVID-19 virus given that various opinion pieces have expressed either positive or negative consequences of taking ACE inhibitors or ARBs. This article goes through an extensive biology discussion and comes to the conclusion that not enough is known now to say if there is any benefit or harm with taking these two classes of hypertension medications with respect to the COVID-19 virus. However, the author correctly points out that there is a reason that a person is taking a hypertension medication and to think carefully about an unknown potential benefit from stopping usage of that medication vs. the risk of hypertension.


          • #8
            Tom I understand both arguments are theories at this point and both arguments sound logical to some extent. What I don't understand is how they go from receptor upregulation potential of both ACE2i and ARB and make it sound like both drugs can increase risk.

            Upregulation has to have an upper limit or we'd need ever increasing doses of ARB since an ARB alone increases both free ACE2 and angiotensin II as I understand it and ever more receptors would reduce the % of blockade.

            ARBs are actually blocking the receptors as opposed to ACE2i blocking conversion of what binds to them. If the body upregulated 100 normal receptors to 120 after inhibition or blockade then all 120 receptors would be free with inhibition and if a blocker blocked 80/100 it would still block at least 80/120 if the body upregulated. My personal opinion based on how I understand this is ARBs should block some virus from attaching/entering via ACE2 receptors. Unless the virus has orders of magnitude higher binding affinity (IC50 type measurement iirc) it should have less receptors to use.

            Now is that enough to stop or ameliorate the sickness or symptoms at current therapeutic doses? I've no clue and that will require data. Out of all the dead and sick though I'm surprised they can't pull at least preliminary data on numbers receiving ACEi and ARB. Per the article you linked

            Liu et al

            was the only thing I saw that really mentioned HTN and patients with COVID. I really don't see how the world can't combine their data and at least get more fine grained - 30% of COVID patients had HTN, of those 15% were on ARBs and 15% on ACEi or whatever. Given the data I could have it in a database and searched and sorted by that in under an hour, how can all these scientists and doctors or even some weaponized autist from 4,chan not have hacked together this information yet.


            • #9
              I am hoping that we will get some clarifying data sooner than later. I can imagine that the Italian health authorities are overwhelmed and thus finding it difficult to provide what to us is critical data. Here is a Tony Fauci interview with the JAMA editor-in-chief about this particular issue among many others. For the hypertension part, go to the 12:20 mark or so on the video.


              • #10
                He mentions hypertension but how much hypertension is due to undiagnosed prediabetes or worsening insulin resistance but still being subclinical in terms of actually being diagnosed? The few studies I saw at a quick glance mentioned insulin resistance was worse is 25% and up of patients with essential hypertension.

                He also mentioned the lack of data on the treatments the hypertensive patients were receiving. I really don't see how that data hasn't been made public yet.


                • Tom
                  Tom commented
                  Editing a comment
                  They have had some dead peoples' bodies abandoned in care homes. It is that bad in some places as the entire medical system in northern Italy is under tremendous strain. Interestingly the number of cases further in southern Italy is significantly less from what I have heard.

              • #11
                Tom New York Times just released all data they've compiled so maybe know we'll see some hope come out of it.