Cardio-Vascular Complications of Hydroxychloroquine Use: Can Impact COVID-19 Pandemic

  • Taruna Singh
  • Rakshit Arora
  • Amrit Sharma
Keywords: Hydroxychloroquine, COVID-19, Coronavirus

Abstract

As the coronavirus pandemic is on the rise, many compounds with anti-viral properties are under investigation. Hydroxychloroquine (HCQ) being the daily debated daily during this COVID-19 pandemic is an immunomodulatory drug which has been used for indications like malaria, systemic lupus erythematosus and arthritis. Although some researchers have claimed its effectiveness against coronavirus, it results in proarrhythmic effects and drug-induced long QT syndrome. These cardiac issues while using hydroxychloroquine, have limited its use against coronavirus. A literature search was performed, and general safety information of this drug was collected. It can be concluded that this drug leads to cardiovascular events, heart disease, hypotension, tachycardia, and QT interval prolongation, sometimes in combination with other drugs and should be prescribed to the patients only after thoroughly estimating its benefit risk ratio.

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Author Biographies

Taruna Singh

MBBS, M.SC (Forensic Medicine), Private Practitioner and Consultant Doctor, New Delhi, India

Rakshit Arora

MBBS, Private Practitioner, New Delhi

Amrit Sharma

MDS (Oral Pathology), Consultant Dental Surgeon, Shiva Dental Clinic, Gajraula, Uttar Pradesh, India

References

Chen Z, Hu J, Zhang Z, et al. Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial. Medrxiv. Epub 10 Apr 2020. https://doi.org/10.1101/2020.03.22.20040758.

Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020;105949.

Ruiz-Irastorza G, Ramos-Casals M, Brito-Zeron P, et al. Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review. Ann Rheum Dis. 2010;69(1):20-8.

Savarino A, Boelaert JR, Cassone A, Majori G, Cauda R. Effects of chloroquine on viral infections: an old drug against today’s diseases? Lancet Infect Dis. 2003;3:722-7.

Projean D, Baune B, Farinotti R, et al. In vitro metabolism of chloroquine: identification of CYP2C8, CYP3A4, and CYP2D6 as the main isoforms catalyzing N-desethylchlo¬roquine formation. Drug Metab Dispos. 2003;31:748-54.

Lee JY, Vinayagamoorthy N, Han K, et al. Association of polymorphisms of cytochrome P450 2D6 with blood hydroxychloroquine levels in patients with systemic lupus erythematosus. Arthritis Rheumatol. 2016;68:184-90.

Hancox JC, Hasnain M, Vieweg WV, Crouse EL, Baranchuk A. Azithromycin, cardiovascular risks, QTc interval prolongation, torsade de pointes, and regulatory issues: a narrative review based on the study of case reports. Ther Adv Infect Dis. 2013;1:155-65.

Ray WA, Murray KT, Hall K, Arbogast PG, Stein CM. Azithromycin and the risk of cardiovascular death. N Engl J Med. 2012;366:1881-90.

Chatre C, Roubille F, Vernhet H, Jorgensen C, Pers YM. Cardiac complications attributed to chloroquine and hy¬droxychloroquine: a systematic review of the literature. Drug Saf. 2018;41:919-31.

Tselios K, Deeb M, Gladman DD, Harvey P, Urowitz MB. Antimalarial-induced cardiomyopathy: a systematic review of the literature. Lupus 2018;27:591-9.

Costedoat-Chalumeau N, Hulot JS, Amoura Z, et al. Heart conduction disorders related to antimalarials toxicity: an analysis of electrocardiograms in 85 patients treated with hydroxychloroquine for connective tissue diseases. Rheumatology 2007; 46: 808-10.

Capel RA, Herring N, Kalla M, et al. Hydroxychloroquine reduces heart rate by modulating the hyperpolarization-activated current If: Novel electrophysiological insights and therapeutic potential. Heart Rhythm 2015;12:2186-94.

Mzayek F, Deng H, Mather FJ, et al. Randomized dose-ranging controlled trial of AQ-13, a candidate antimalarial, and chloroquine in healthy volunteers. PLoS Clin Trials. 2007;2(1):e6.

Viskin S, Justo D, Halkin A, et al. Long QT syndrome caused by noncardiac drugs. Prog Cardiovasc Dis. 2003;45(5):415-27.

Tomaselli Muensterman E,Tisdale JE. Predictive analytics for identification of patients at risk for QT interval prolongation: a systematic review. Pharmacotherapy. 2018;38(8):813-21.

Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis. Epub 12 Mar 2020. https://doi.org/10.1016/j.ijid.2020.03.017.

Choi Y, Lim HS, Chung D, et al. Risk evaluation of azithromycin-induced QT prolongation in real-world practice. Biomed Res Int. 2018;2018:1574806.

Chorin E, Dai M, Shulman E, et al. The QT interval in patients with SARS-CoV-2 infection treated with hydroxychloroquine/ azithromycin. Medrxiv. Epub 3 apr 2020. https://doi.org/10.1101/2020.04.02.20047050.

Murphy M, Carmichael AJ. Fatal toxic epidermal necrolysis associated with hydroxychloroquine. Clin Exp Dermatol. 2001;26(5):457-8.

Cameron MC, Word AP, Dominguez A. Hydroxychloroquine induced fatal toxic epidermal necrolysis complicated by angioinvasive rhizopus. Dermatol Online J. 2014;20(11):13030/qt1q90q0h5

Guillaume JC, Roujeau JC, Revuz J, et al. The culprit drugs in 87 cases of toxic epidermal necrolysis (Lyell’s syndrome). Arch Dermatol. 1987;123(9):1166-70.

Johnson A, Eck LM. Hydroxychloroquine-associated hyperinsulinemic hypoglycemia [poster P3-471]. Endocr Rev. 2011;32.

Powrie JK, Smith GD, Shojaee-Moradie F, et al. Mode of action of chloroquine in patients with non-insulin-dependent diabetes mellitus. Am J Physiol. 1991;260(6 Pt 1):E897- 904.

Published
2020-06-20
How to Cite
Taruna Singh, Rakshit Arora, & Amrit Sharma. (2020). Cardio-Vascular Complications of Hydroxychloroquine Use: Can Impact COVID-19 Pandemic. International Healthcare Research Journal, 4(3), 56-59. https://doi.org/10.26440/IHRJ/0403.06349