Safety considerations with chloroquine, hydroxychloroquine and azithromycin in the management of SARS-CoV-2 infection

Severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) has spread rapidly around the globe in recent months. With deaths from its associated disease, coronavirus disease 2019 (COVID-19), projected to reach into the millions and a vaccine unlikely in the near term, the search is on for existing...

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Bibliographic Details
Published in:Canadian Medical Association journal (CMAJ) 2020-04, Vol.192 (17), p.E450-E453
Main Author: Juurlink, David N
Format: Article
Language:English
Subjects:
Analysis
Antibiotics
Antiviral Agents - adverse effects
Antiviral Agents - therapeutic use
Arrhythmias, Cardiac - chemically induced
Azithromycin - adverse effects
Azithromycin - therapeutic use
Betacoronavirus
Care and treatment
Chloroquine - adverse effects
Chloroquine - therapeutic use
Chronic illnesses
Coronavirus Infections - drug therapy
Coronaviruses
COVID-19
Cytochrome
Drug dosages
Health aspects
Humans
Hydroxychloroquine
Hydroxychloroquine - administration & dosage
Hydroxychloroquine - adverse effects
Hydroxychloroquine - therapeutic use
Hypoglycemia
Inflammatory diseases
Insulin
Lupus
Malaria
Mental disorders
Monitoring, Physiologic
Pandemics
Patient safety
Patient Selection
Pharmacology
Pneumonia, Viral - drug therapy
Prevention
Review
Rheumatoid factor
Safety and security measures
Severe acute respiratory syndrome
Severe acute respiratory syndrome coronavirus 2
Systemic lupus erythematosus
Type 2 diabetes
Vaccines
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Summary:Severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) has spread rapidly around the globe in recent months. With deaths from its associated disease, coronavirus disease 2019 (COVID-19), projected to reach into the millions and a vaccine unlikely in the near term, the search is on for existing drugs that might prevent COVID-19 or improve outcomes for patients who have COVID-19. Chloroquine and its derivative hydroxychloroquine, which have been used for decades in the treatment and prevention of malaria as well as chronic inflammatory diseases such as rheumatoid arthritis and systemic lupus erythematosus, have received much attention as potential therapies. The use of either chloroquine or hydroxychloroquine and azithromycin for treatment or prevention of SARS-CoV-2 infection is currently supported primarily by in vitro data and weak studies involving humans. Physicians and patients should be aware of several uncommon but potentially life-threatening adverse effects should these drugs be used before better-designed studies determine their benefit, if any, in treating or preventing COVID-19. Harms of treatment can be mitigated by careful patient selection and monitoring.
ISSN:0820-3946
1488-2329
DOI:10.1503/cmaj.200528