Brief Review of Chloroquine and Hydroxychloroquine Toxicity and Management

Jacob A. Lebin, MD; Kathy T. LeSaint, MD

Disclosures

Western J Emerg Med. 2020;21(4):760-763. 

In This Article

Abstract and Introduction

Abstract

As of April 21, 2020, more than 2.5 million cases of coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, have been reported in 210 countries and territories, with the death toll at 171,810. Both chloroquine and hydroxychloroquine have gained considerable media attention as possible therapies, resulting in a significant surge in demand. In overdose, both medications can cause severe, potentially life-threatening effects. Here, we present a brief overview of the pharmacology of chloroquine and hydroxychloroquine, manifestations of toxicity, and treatment considerations.

Introduction

As of April 21, 2020, more than 2.5 million cases of coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, have been reported in 210 countries and territories, with the death toll at 171,810.[1] While extensive research is underway to evaluate the efficacy of numerous antiviral and other immunomodulatory medications against COVID-19, chloroquine (CQ) and hydroxychloroquine (HCQ), in particular, have gained considerable attention. Data to support the use of CQ and HCQ for COVID-19 are limited and inconclusive, as its use against SARS-CoV-2 has been demonstrated in vitro and in small, poorly controlled, or uncontrolled clinical trials.[2–4]

Since being prominently featured in the press as a potential COVID-19 therapy, demand for CQ and HCQ has exploded. On March 31, 2020, the United States Food and Drug Administration added both medications to its drug shortages webpage due to a significant surge in demand.[5] Soon after, the California Department of Consumer Affairs reported that healthcare providers were wrongfully hoarding and prescribing CQ or HCQ for themselves and family members for COVID-19 prophylaxis despite a lack of evidence to support this use.[6] In response, several states have issued emergency restrictions on how CQ and HCQ can be dispensed.

Unfortunately, the media attention and the increase in usage of CQ and HCQ do not come without significant consequences. Both medications, when taken in overdose, can cause severe, potentially life-threatening effects. On March 23, 2020, an Arizona man died after an overdose of chloroquine phosphate, formulated as an aquarium cleaner.[7] In light of recent events, we anticipate emergency departments may see a rise in cases of acute and chronic toxicity from CQ and/or HCQ. Here, we present a brief overview of the pharmacology of CQ and HCQ, manifestations of toxicity, and treatment considerations.

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