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Clinical Medicine | Clinical Pharmacology | #covid4md #MedTwitter | my tweets ≠ medical advice | 🍄🍀🍄
19 Apr
1/6 Two proposed interventions from Li Taisheng, the director of ID dept. of Peking Union Medical College Hospital; he works on the frontline for #SARSCoV2 and SARSCov1

🔸1. "Give IV immunoglobulin as soon as possible. Firstly, IVIG can boost the body's immune response;"
2/6 "more importantly, IVIG can interrupt the inflammatory process. If this stage is missed, a large dose of glucocorticoids could be given later but it would cause a decline in the patient's immune system and induce various complications."
3/6 "According to the clinical effects, if IVIG could be given on around day 7 after symptoms onset, or as soon as the biological indicators deteriorated, most likely it would help prevent the patients' condition worsening."
Read 6 tweets
17 Apr
Thank Dr. Jankelosn for replying my email about the dosage regimen used in this study: QT intervals & HCQ+Azi in treating #Covid_19
medrxiv.org/content/10.110…
🔸#HydroxyChloroquine 400mg BID on day 1 followed by 200mg BID for 4 days, plus Azithromycin 500md x1 for 5 days
🔸Baseline QT intervals: ~435
🔸11% of patients QT increased to >500ms
🔸Creatinine and renal function are significantly important factors for QT prolongations.
🔹The QT intervals were increasing daily, which seems to be related to the elevating blood concentrations of HCQ
Read 4 tweets
10 Apr
1/7 France has done the first pharmacokinetic (PK) study of HCQ for ICU patients of #COVID19, a fantastic job for dosage optimization.
🔸13 patients, average weight=82.7 kg
🔸46% pts BMI>30
🔸12 on mechanical ventilators
🔸1 on ECMO
🔸30.7% with medium/severe renal dysfunction
2/7
🔸2 pts had QT prolongations (>500ms ), but not related to HCQ levels.
🔸 Regimen D: 200mgX3/day for 7 days;
PK simulation shows HCQ reached the therapeutic level of 1mg/L on day 2.5 but exceeds 2mg/L (risk of ocular toxicity) on day 5
3/7
🔺In this D regimen, the average HCQ dose is ~7.5 mg/kg/day, which is above the well established safe upper limit: 6.5 mg/kg/day; meanwhile, the HCQ blood concentration exceeds the upper safe level: 2mg/L.
Read 7 tweets