Hidroxychloroquine (HQ) basics for non-rheum in COVID-19:
- Increases endosomal pH, interferes with the glycosylation of cellular receptors of SARS-CoV2.
- In vitro activity in SARS-CoV and SARS-CoV2.
Proposed dosing (COVID-19): 400 mg bid 1 day➡️200 mg bid 4 days. Longer tx?
- Increases endosomal pH, interferes with the glycosylation of cellular receptors of SARS-CoV2.
- In vitro activity in SARS-CoV and SARS-CoV2.
Proposed dosing (COVID-19): 400 mg bid 1 day➡️200 mg bid 4 days. Longer tx?
Usually very well tolerated, most of adverse effects after months/years of therapy!
Better profile compared to chloroquine.
- Retinopathy. After long time-exposure, risk factors: > 5 mg/kg/day, renal insufficiency, tamoxifen use, obesity...
Not a problem for short term.
Better profile compared to chloroquine.
- Retinopathy. After long time-exposure, risk factors: > 5 mg/kg/day, renal insufficiency, tamoxifen use, obesity...
Not a problem for short term.
- Skin. Pruritus, rash, photosensibility...
- Myopathy. Rare. Usually long term use (1 year-10 years). Neuromyopathy (lisosomal changes, vacuoles in biopsy). Simmetrical weakness+/- sensitive symptoms.
- Myopathy. Rare. Usually long term use (1 year-10 years). Neuromyopathy (lisosomal changes, vacuoles in biopsy). Simmetrical weakness+/- sensitive symptoms.
- Cardiomyopathy: Rare, hipertrophy (usually long exposure).
- Arrhythmia, QTc prolongation... Usually in intoxication and long treatments. Note: Lopinavir/Ritonavir also can cause long QT --> EKG!
- Safe in pregnancy!
- Arrhythmia, QTc prolongation... Usually in intoxication and long treatments. Note: Lopinavir/Ritonavir also can cause long QT --> EKG!
- Safe in pregnancy!
Other precautions:
Don´t use it in glucose-6-phosphate dehydrogenase deficiency.
Precaution in chronic kidney disease (not recomended if CrCl < 10 ml/min).
Increases digoxin toxicity.
Don´t use it in glucose-6-phosphate dehydrogenase deficiency.
Precaution in chronic kidney disease (not recomended if CrCl < 10 ml/min).
Increases digoxin toxicity.
Key points:
- Usually very well tolerated and few adverse effects (mostly after long time exposure, high doses...).
- Safe in pregnancy.
- As lopinavir/ritonavir could cause long QT --> EKG, check for other treatments.
#covid4Rheum #COVID19 #Rheumatology
- Usually very well tolerated and few adverse effects (mostly after long time exposure, high doses...).
- Safe in pregnancy.
- As lopinavir/ritonavir could cause long QT --> EKG, check for other treatments.
#covid4Rheum #COVID19 #Rheumatology
