|Year : 2020 | Volume
| Issue : 3 | Page : 208-209
Hydroxychloroquine, COVID-19, and prophylaxis
Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India; partment of Community Medicine, Hainan Medical University, Haikou, China; Department of Community Medicine, Faculty of Medicine, University of Nis, Nis, Serbia; Department of Community Medicine, Joseph Ayobabalola University, Ikeji-Arakeji, Nigeria
|Date of Submission||01-May-2020|
|Date of Decision||08-May-2020|
|Date of Acceptance||08-May-2020|
|Date of Web Publication||3-Jun-2020|
Professor, Dr. DY Patil University, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Wiwanitkit V. Hydroxychloroquine, COVID-19, and prophylaxis. Med J DY Patil Vidyapeeth 2020;13:208-9
As a new emerging infection, the effective treatment for COVID-19 is still unavailable. There are several attempts to find new drugs to manage this infection. At the same time, there are attempts to use classical available drug for trial treatment of the patients. Many drugs including antiretroviral drugs, antibiotics, antimalarial drug, and hydroxychloroquine are presently being tested for efficacy in treatment of COVID-19. Hydroxychloroquine is one of the drugs mentioned for its effectiveness in COVID-19 patients. Presently, this drug is used in rheumatology for treating systemic lupus erythematosus (SLE) and patients with other autoimmune conditions. The extremely low incidence of COVID-19 among patients with underlying SLE is an important clue triggering the study of efficacy of hydroxychloroquine against COVID-19.
If hydroxychloroquine is used for treatment of patients with COVID-19, effectiveness of the drug is the main parameter to be evaluated. In addition, the safety of the drug has to be verified. Meyerowitz et al. noted that the drug “should only be used with caution and in the context of carefully thought out clinical trials, or on a case-by-case basis after rigorous consideration of the risks and benefits of this therapeutic approach.” In the above study, the safety of the drug is reported. According to this study on “Adverse drug reaction profile of prophylactic hydroxychloroquine for COVID-19 amongst doctors,” there is no serious adverse reaction of the drug in the sample of doctors observed.
In fact, the risk of using hydroxychloroquine for treatment of COVID-19 is an important issue to be addressed. The single use or combination with antibiotics such as azithromycin might cause clinical problem. An important basic risk of using hydroxychloroquine is the triggering of hemolytic episode in patients with underlying glucose-6-phosphate dehydrogenase (G6PD) deficiency. This is a common genetic disorder in many areas of the world; the risk in these regions should be kept in mind. Another important risk of using hydroxychloroquine for COVID-19 treatment is cardiac complication. Acquired long QT syndrome is a possible adverse effect due to proarrhythmic effects of hydroxychloroquine., A rarer unwanted adverse effect on hepatic function is also reported on using hydroxychloroquine in patients with COVID-19. Using hydroxychloroquine is reported for possible induction of “10-fold increase in serum levels of transaminases” in COVID-19 patients. When used for prophylaxis in people with cardiac and hepatic conditions, monitoring of electrocardiogram and liver function tests is recommended.
However, since hydroxychloroquine is a classical drug that is not expensive and is already adapted in management of many clinical problems such as diabetes, Singh et al. noted that it is “worthy of fast-track clinical trial for treatment, and may be carefully considered for clinical use as experimental drug.” At least, if hydroxychloroquine is selected for treatment of patients with COVID-19, a simple test for G6PD deficiency is required before starting of hydroxychloroquine. Finally, if the drug is finally confirmed for effectiveness and safety, the further issue to be studied is the proper dosage for use in management of COVID-19.
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