A call to caution when hydroxychloroquine is given to elderly patients with COVID-19

Abstract

Introduction Use of hydroxychloroquine in patients with coronavirus disease 2019 (COVID-19) was widespread and uncontrolled until recently. Patients vulnerable to severe COVID-19 are at risk of hydroxychloroquine interactions with co-morbidities and co-medications contributing to detrimental, including fatal, adverse treatment effects. Methods A retrospective survey was undertaken of health conditions and co-medications of patients with COVID-19 who were pre-screened for enrolment in a randomized, double-blind, placebo-controlled hydroxychloroquine multi-centre trial. Results The survey involved 305 patients [median age 71 (interquartile range 59–81) years]. The majority of patients ( n = 279, 92%) considered for inclusion in the clinical trial were not eligible, mainly due to safety concerns caused by health conditions or co-medications. The most common were QT-prolonging drugs ( n = 188, 62%) and haematologic/haemato-oncologic diseases ( n = 39, 13%) which prohibited the administration of hydroxychloroquine. In addition, 165 (54%) patients had health conditions and 167 (55%) patients were on co-medications that did not prohibit the use of hydroxychloroquine but had a risk of adverse interactions with hydroxychloroquine. The most common were diabetes ( n = 86, 28%), renal insufficiency ( n = 69, 23%) and heart failure ( n = 58, 19%). Conclusion The majority of hospitalized patients with COVID-19 had health conditions or took co-medications precluding safe treatment with hydroxychloroquine. Therefore, hydroxychloroquine should be administered with extreme caution in elderly patients with COVID-19, and only in clinical trials.

Hypertension related toxicity of chloroquine explains its failure against COVID-19: Based on rat model

“…In addition to the dose regimens of CQ, the comorbid conditions of patients (e.g. heart disease and hypertension) may affect the outcomes of clinical evaluation ( Gabor et al, 2021 ), unfortunately, persons with comorbidities were excluded in most trials, leading to a lack of available data for patients in these subgroups ( Skipper et al, 2020 ; Tang et al, 2020 ). For hypertensive patients, CQ plays an antihypertension role as shown in one preclinical study ( Wu et al, 2017 ), which is consistent with our data.…”

“…Nonetheless, hepatotoxicity and nephrotoxicity are closely related to high dose CQ treatment in the clinic, and are reversible upon drug withdrawal. Concerning the complexity of COVID-19 patient conditions especially in the elderly population with high risk of liver and kidney injury ( Gabor et al, 2021 ), the alternative use of CQ should be approached with extreme caution and only in clinical trials.…”