There is still limited data on the safety and efficacy of hydroxychloroquine and chloroquine phosphate but these drugs are being investigated for use in confirmed cases of the Covid-19 and as prophylactic drug to prevent infection in persons who were exposed to positive cases like household contacts and healthcare workers.
Recommended dosages are based on initial available data.
Among its most common adverse or toxic effects are retinopathy and permanent blindness. Retinopathy occurs in one to 10 percent of cases. The toxicity is dependent on the level of the drug in the blood. Early changes may be reversible but if advanced, the eye damage may progress even if the drug is discontinued.
Heart disease can arise from the use of the drugs. Heart dysfunction called cardiomyopathy may lead to severe heart failure that can cause death. This can present as heart block, pulmonary hypertension, sick sinus syndrome, and can occur during initial use and prolonged use.
Fifteen to 25 percent of the drug is eliminated by the kidneys so caution is observed when used in patients with impaired kidney function.
The drugs should not be used by persons allergic to it and by persons who already have retinopathy. It is not given to Covid-19 cases with the following: electrocardiogram findings showing heart block or arrhythmia; abnormal liver function tests that denote liver damage or inflammation (5-6X elevation of aspartate transaminase or alanine transaminase); deficiency of the enzyme G6PD. Use of the drugs in these patients may lead to bleeding and hemolytic anemia; and severe heart failure.
Drug interactions include the following: It can enhance the blood sugar lowering effects of drugs used for diabetes mellitus; Increase the blood levels of antipsychotic drugs like phenothiazines; and decrease the metabolism or breakdown of some betablockers which are used to control blood pressure or treat heart disease.
Azithromycin is another drug under investigation for the treatment of the Covid-19 infection. It is an antibiotic classified as a macrolide and is commonly used for respiratory tract or lung infection. It was used in combination with hydroxychloroquine in a small study which showed decrease in the amount of virus (viral load) in patients. Dosage recommendations will be given once its safety and efficacy is established. No adjustment in dose is done in patients with kidney function impairment. Caution is advised among patients with liver disease. There is still no evidence to show that it can be used to prevent infection with the virus.
There is still little information on the Covid-19 infection on pregnancy. Pregnant women should follow the same recommendations as non-pregnant persons to avoid exposure and infection. It is suggested that pregnant workers in the third trimester, especially 36 weeks and above, should stop contact with patients.
The signs and symptoms of infection resemble those in the general population. Pregnancy does not appear to increase susceptibility to infection or make the course of the disease worse. Most infected mothers recover but severe disease requiring intensive care may occur. Infected women who develop pneumonia may have increased frequency to have preterm complications. It is still under investigation if infection of the fetus inside the uterus occurs.
“My hope comes from Him.” Psalm 62:5.
Happy Easter to everyone.