Hydroxychloroquine: risk of QT prolongation and drug interactions
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Hydroxychloroquine: risk of QT prolongation and drug interactions Hydroxychloroquine [Plaquenil] is associated with a risk of QT interval prolongation and drug interactions when used in the management of COVID-19, warns the Malaysian National Pharmaceutical Regulatory Agency (NPRA). Hydroxychloroquine alone or in combination with other drugs is not approved for the treatment of COVID-19, but has been used off-label for this infection. It has been documented to cause dose-dependent QT interval prolongation, and is associated with a risk of cardiac adverse events (AEs) which is increased when the drug is used in patients receiving other drugs which prolong the QT interval (antiarrhythmics, tricyclic antidepressants, antipsychotics and anti-infectives including azithromycin), and in patients with pre-existing conditions which potentiate the risk of QT interval prolongation (heart disease, heart failure, myocardial infarction, bradycardia, hypocalcaemia, hypokalaemia and/or hypomagnesaemia, or a history of ventricular arrhythmias). Serious and life-threatening AEs reported after the use of hydroxychloroquine in patients with COVID-19 include QT interval prolongation, torsades de pointes, syncope, heart arrest and sudden death. Hydroxychloroquine is also associated with known drug interactions with antacids; CYP2C8 and CYP3A4 inhibitors including cimetidine, clarithromycin, clopidogrel, gemfibrozil, itraconazole, ritonavir and grapefruit juice; and CYP2C8 and CYP3A4 inducers including carbamazepine, hypericum (St John’s Wort), phenobarbital and rifampicin. It has an inhibitory effect on P-glycoprotein substrates including ciclosporin, dabigatran and digoxin. The NPRA has approved a Direct Healthcare Professional Communication issued by Sanofi-aventis (Malaysia) regarding this safety concern. National Pharmaceutical Regulatory Agency, Ministry of Health Malaysia. Plaquenil (hydroxycholoroquine): Risk of QT prolongation and other drug-drug interactions in the context of COVID-19 management. Internet Document : 14 Aug 2020. Available from: URL: https://npra.gov.my/index.php/en/component/content/article/419-english/safetyalerts-main/safety-alerts-2020/1527144-plaquenil-hydroxycholoroquine-risk-of-qt-prolongation-and-other-drug-drug-interactions-in-the-context-of803498597 covid-19-management.html?Itemid=1391
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Reactions 29 Aug 2020 No. 1819
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