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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:
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).