News Release 8-Apr-2020

Canadian Medical Association Journal

Chloroquine, hydroxychloroquine and azithromycin are being used to treat and prevent COVID-19 despite weak evidence for effectiveness, and physicians and patients should be aware of the drugs’ potentially serious adverse events, states a review in CMAJ (Canadian Medical Association Journal).

“Physicians and patients should be aware of several rare but potentially life-threatening adverse effects of chloroquine and hydroxychloroquine,” says Dr. David Juurlink, Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre, and a senior scientist at ICES.

The review provides an overview of potential harms associated with these drugs as well as their management based on the best available evidence.

Potential adverse effects include

• Cardiac arrhythmias
• Hypoglycemia
• Neuropsychiatric effects, such as agitation, confusion, hallucinations and paranoia
• Interactions with other drugs
• Metabolic variability (some people metabolize chloroquine and hydroxychloroquine poorly and a small percentage metabolize them rapidly, which affects the response to treatment)
• Overdose (chloroquine and hydroxychloroquine are highly toxic in overdose and can cause seizures, coma and cardiac arrest)
• Drug shortages (patients with autoimmune disorders such as rheumatoid arthritis, lupus and other chronic diseases, who take hydroxychloroquine to treat these conditions could have problems accessing this drug)

The review summarizes the poor quality of evidence suggesting that these treatments might be beneficial in patients with COVID-19 and cautions that it is possible that these treatments could worsen the disease.

“Despite optimism (in some, even enthusiasm) for the potential of chloroquine or hydroxychloroquine in the treatment of COVID-19, little consideration has been given to the possibility that the drugs might negatively influence the course of disease,” says Dr. Juurlink. “This is why we need a better evidence base before routinely using these drugs to treat patients with COVID-19.”

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“Safety considerations with chloroquine, hydroxychloroquine and azithromycin in the management of SARS-CoV-2 infection” is published April 8, 2020.

氯喹，羥氯喹和阿奇黴素治療COVID-19的潛在危害

2049/5000CMAJ（Canadian Medical Association Journal）的一項評論指出，儘管有效性證據不足，但氯喹，羥氯喹和阿奇黴素仍被用於治療和預防COVID-19，醫師和患者應注意該藥物潛在的嚴重不良事件。

“醫師和患者應意識到氯喹和羥氯喹的幾種罕見但可能危及生命的不良反應，”桑尼布魯克健康科學中心臨床藥理和毒理學部主任兼國際消費電子展（ICES）的David Juurlink博士說。

審查基於最佳證據，概述了與這些藥物相關的潛在危害及其管理。

潛在的不良影響包括

    心律失常
    低血糖症
    神經精神疾病的影響，例如躁動，神誌不清，幻覺和妄想症
    與其他藥物的相互作用
    代謝變異性（某些人代謝較弱的氯喹和羥氯喹，一小部分人迅速代謝，從而影響對治療的反應）
    過量（氯喹和羥氯喹在過量時有劇毒，可引起癲癇，昏迷和心臟驟停）
    藥物短缺（患有自身免疫性疾病（例如類風濕性關節炎，狼瘡和其他慢性疾病的患者，他們服用羥氯喹治療這些疾病可能會難以使用該藥物）

該綜述總結了證據質量差，表明這些治療方法可能對COVID-19患者有益，並警告說這些治療方法可能會使疾病惡化。

Juurlink博士說：“儘管人們對氯喹或羥氯喹在治療COVID-19方面的潛力感到樂觀（甚至有些熱情），但很少考慮藥物對疾病進程產生負面影響的可能性。” “這就是為什麼在常規使用這些藥物治療COVID-19患者之前，我們需要更好的證據基礎。”