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QTc interval prolongation and torsades de pointes following off-label use: case report In an observational retrospective study of 251 patients, a 68-year-old man was described, who developed QTc interval prolongation and torsades de pointes following off-label treatment with hydroxychloroquine and azithromycin for COVID-19. The man, who was hospitalised with COVID-19, started receiving off-label treatment with oral hydroxychloroquine 400mg twice a day (loading dose) for 1 day followed by 200mg twice a day for 4 days and oral azithromycin 500 mg/day for 5 days. Prior to initiation of COVID-19 treatment, his ECG showed QTc interval of 447ms. After the initiation of the treatment, his ECGs showed prolongation of the QTc which was 477ms on day 1, 480ms on day 2 and 505ms on day 3 of the treatment. On day 4, his ECG again showed prolongation of the QTc at 546ms. On the same day at night, he had polymorphic ventricular tachycardia and his telemetry showed multiple short runs of torsade de pointes. It was suspected that prolongation of the QTc interval and torsades de pointes were secondary to hydroxychloroquine and azithromycin treatment[duration of treatment to reaction onset not stated]. Therefore, the man’s treatment with hydroxychloroquine and azithromycin was discontinued and cardioversion was performed [outcome not stated]. Chorin E, et al. QT interval prolongation and torsade de pointes in patients with COVID-19 treated with hydroxychloroquine/azithromycin. Heart Rhythm 17: 1425-1433, No. 803501368 9, Sep 2020. Available from: URL: http://doi.org/10.1016/j.hrthm.2020.05.014

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Reactions 19 Sep 2020 No. 1822