Chloroquine and COVID-19: Should We Care about Ototoxicity?

Abstract

Introduction Severe acute respiratory syndrome coronavirus 2 was first described in December 2019 in China leading to a Public Health Emergency of International Concern. It was named by the World Health Organization as Coronavirus Disease 2019 (COVID-19), and it garnered unprecedented attention from public health researchers around the world, and studies analyzing chloroquine and hydroxychloroquine as a possible therapy have arisen in the last 2 months. Objective To review the literature and describe updated facts about the ototoxicity of chloroquine and hydroxychloroquine, an important side effect that can be present in patients with COVID-19 treated with these drugs. Data Synthesis The most typical treatment regimen is 5 days of hydroxychloroquine at daily doses of 400 to 600 mg. There is no randomized clinical trial that can prove so far the efficacy of this medication, and few studies have evaluated adverse events potentially linked to their use in patients with COVID-19. While there is no concrete evidence on the incidence of ototoxicity using chloroquine in the short term, we need to consider that, as a pandemic disease, millions of patients with COVID-19 may receive this treatment, and ototoxicity can be a possible adverse event. Conclusion Despite the urgent global situation caused by the COVID-19, the risk of irreversible hearing loss may outweigh the unproven benefit of using hydroxychloroquine or chloroquine, especially in patients with mild forms of COVID-19, who may be cured with supportive treatment. The potential hearing loss that can be caused by these medications may advise against their use in COVID-19 patients.

The Ototoxicity of Antimalarial Drugs—A State of the Art Review

“…Antimalarial drugs, such as CQ and HCQ, were considered for a long time as having audio-vestibular side effects (47,48). QN overdose is generally known as cinchonism.…”

COVID-19 and hearing loss—A narrative review

“…Apart from SARS-CoV-2 itself, many medications used to treat patients with COVID-19 are considered potentially ototoxic. These medications include quinine-derivatives (Altulea et al, 2021;Singh et al, 2021), which were ineffective in treating COVID-19 infection, loop diuretics, and antiviral drugs (Monteiro, 2020;Prayuenyong et al, 2020;Coffin et al, 2021;De Luca et al, 2021;Little and Cosetti, 2021). Admission to the intensive care unit (ICU) also confounds the incidence of SNHL in COVID-19 patients, given that these patients are more likely to be treated with ototoxic loop diuretics and may require dialysis for renal insufficiency or suffer from septic shock.…”

Assessment of cochlear functions in hospitalized patients with SARS-CoV-2 infection

“…There are also so many asymptomatic viruses transmitting to people in the community [3][4][5]. The most common symptoms of COVID-19 infection are fever, cough, fatigue, muscle pain, dyspnea, sore throat, headache, gastralgia, nausea, vomiting, and diarrhea [1,[6][7][8][9]. More than half of patients show symptoms related to Otorhinolaryngology such as a cough, sore throat, anosmia, ageusia, nasal congestion, runny nose, postnasal discharge, gingivitis, otalgia, hoarseness, facial paralysis, rotatory vertigo, dizziness, tinnitus, and sudden sensorineural hearing loss [1,10].…”