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Hydroxychloroquine Clinical Pearls – COVID-19 Buzz

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The world is a buzz with COVID-19 news and rightfully so. I want to cover hydroxychloroquine clinical pearls. This drug has been purported to have activity against coronavirus. Here’s a link to that research article.

Uses of Hydroxychloroquine

While it is classified as an antimalarial agent, the most common, long term use for hydroxychloroquine that I have seen in my practice is rheumatoid arthritis. If I had to guess anecdotally, I would say that Lupus is the second most common chronic indication. Much like methotrexate, hydroxychloroquine is classified as a DMARD.

Adverse Effects of Hydroxychloroquine

The number one adverse effect that you are likely to be tested on in pharmacy school, med school, or other board exams is retinopathy. We must monitor the eyes with the chronic long term use of hydroxychloroquine. This is a cumulative effect, so the likelihood of short term use causing issues with the eyes would be much lower than a patient who has been on the drug for long periods of time.

Liver toxicity is also a concern we need to monitor for when taking the medication on a chronic basis. There are also rare blood disorder effects that can happen (i.e. leukopenia, thrombocytopenia, etc.). In long term therapy, we typically will monitor liver function as well as a CBC to identify potential abnormalities caused by the drug.

Acutely there have been rare reports of psychiatric changes, hypoglycemia in patients receiving diabetes agents that can cause hypoglycemia, and skin reactions. QTc prolongation has been reported as well but is probably not as dramatic as other medications like antipsychotics or quinolone antibiotics.

Hydroxychloroquine Clinical Pearls – Drug Interactions

From a drug interaction perspective, hydroxychloroquine does not have a ton of significant drug interactions. Most of them are cumulative. QTc prolongation risk and hypoglycemic risk are two examples of additive effects that can be compounded with the use of other agents that contribute to those adverse effects. Looking for more on drug interactions?

Hydroxychloroquine Clinical Pearls – Patient Education

My strongest eduction points when teaching patients about hydroxychloroquine involves some of the monitoring parameters as well as the anticipated onset of action. In diseases like RA and Lupus, this drug will likely not be effective right away. This is important to stress in patients seeking relief from their disease and to help encourage adherence in the first few weeks of treatment when they will probably not notice a difference.

Azithromycin was also used as add on therapy in some patients in the above-mentioned study. I discuss azithromycin drug interactions in my latest book: Clinician’s Guide to Common Drug Interactions In Primary Care. It is available as a 10+ hour audiobook (which you can get for free with this link if it is your first book at Audible.com), paperback, and ebook.

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Written By Eric Christianson

March 22, 2020

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