Antimicrobials
Hydroxychloroquine

Hydroxychloroquine

Restricted

N/A
Moderate

Spectrum of Activity

General Information

Malaria Prevention and Treatment Non infectious rheumatoid disorders

Role in therapy for SARS-CoV-2 (COVID-19) is based on theoretical mechanism of action and limited clinical data. Use recommended only in approved clinical trials - Consult Infectious Disease

Short term use: baseline ECG, LFT's, monitor for adverse effects Longer term use:

  • CBC
  • Liver Function
  • ECG
  • Blood glucose
  • Muscle strength Patients on chronic therapy should undergo baseline and annual Ophthalmologic exam

Dizziness, headache, anorexia, nausea, vomiting, bloating, glucose abnormalities. Most serious toxicities associated with long term use.

Serious: Retinopathy, LFT abnormalities, QT prolongation, hemolysis in G6PD deficient patients

Hypoglycemia has been reported even in the absence of concomitant use of antidiabetic agents

Contraindications: Prolonged QTc (avoid if over 500 ms) Myasthenia Gravis Porphyria Retinal Pathology Guidance Documents for COVID-19 have recommended avoiding in patients with Epilepsy Use with caution in preexisting immune compromise

Increased risk for prolonged QTc when given with other QTc prolonging agents

May increase levels/effects of: Renally eliminated beta blockers (examples: atenolol, nadolol, sotalol, acebutolol). Digoxin - monitor for side effects, test level if chronic use Phenothiazines

Levels of hydroxychloroquine may be elevated when used with: Cyclosporine (recommend to avoid combination)

Increased risk for hemolysis when used with dapsone

Hypoglycemia may occur with our without concomittant use of hypoglycemics but the risk maybe further increased if these are taken Fenugreek use may also increase hypoglycemic risk

Consult Infectious Diseases in person or by phone for consideration of any directed COVID-19 therapy

Testing for G6PD deficiency may be recommended

4 aminoquinoline derivative, chloroquine prodrug.
Use when chloroquine not available or if better tolerated than chloroquine.

For Malaria: concentrates in digestive vacuoles of plasmodia residing within the erythrocyte (thus only effective during the "blood stage" of infection). Inhibits heme polymerase resulting in cytotoxic levels of heme and cell death.

Potent inhibitor of SARS-CoV-2 in vitro (presumed similar intracellular mechanism of action).