Hospital Pharmacy - August 2020 - 218

Letter to the Editor

Repurposed Drugs Against COVID-19:
Safety Concerns and Stockout
Jehan Zeb Khan1, Iftikhar Ali2

Hospital Pharmacy
2020, Vol. 55(4) 218-219
! The Author(s) 2020
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/0018578720925387
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and Zair Hassan1

The Severe Acute Respiratory Syndrome Coronavirus 2
(SARS-CoV-2 or COVID-19) first surfaced in Wuhan
(China) in December 2019 and subsequently spread to
other countries.1,2 Since then, it has been recognized as a
public health emergency of global concern. This global
expansion of COVID-19 is on a dangerous trajectory
and poses to wreak havoc on the lives of people. The
outbreak has caused concerns for health care systems
across the globe and mounted fear and anxiety as the
situation continues to worsen. From a standard public
health perspective, every effort is being made to reduce
person to person transmission.
Unfortunately, until the present, no specific effective
and proven pharmacological treatment is available for
SARS-CoV-2 infection.3 Timely identification and
determination of an effective drug to combat and tranquilize the COVID-19 global crisis is the utmost need of
the hour. Results of ongoing clinical trials evaluating new
antiviral compounds targeting SARS-CoV-2 are eagerly
awaited.4,5 Further details on trials can be found
at: https://clinicaltrials.gov/ct2/results?cond=COVID-19,
http://www.chictr.org.cn/abouten.aspx. While such trials
are underway, some repurposed drugs have shown promising results in the management of COVID-19 patients.5,6
These drugs include Chloroquine (CQ), its molecular
cousin Hydroxychloroquine (HCQ), azithromycin, and
certain monoclonal antibodies. It can be anticipated that
these drugs are not a harmless panacea and carry safety
concerns. Especially, the antimalarial drugs CQ and
HCQ owing to their potential to cause intravascular haemolysis in glucose 6 phosphate dehydrogenase (G6PD)deficient patients, QT prolongation and Torsade de
pointes, hypokalemia, hypoglycemia, mental status
changes, significant drug interactions, and retinitis/retinopathy (especially with long-term use). These drugs have been
used for decades in the treatment of malaria and inflammatory diseases. Although the safety profile of both drugs is
well documented at usual doses, the therapeutic window is
quite narrow (cardiotoxicity/arrhythmias, G6PD concerns), requiring caution for use at higher cumulative
dosages.
Contemplating this, majority of the elderly patients
and those who had cardiovascular comorbidities were

a soft target of COVID-19, as these patients often
have cardiac arrhythmias.7,8 CQ, HCQ, azithromycin,
and some antiviral drugs could possibly multiply the
risk of cardiac-related death.
Currently, evidence for using CQ and HCQ for
COVID-19 comes from in vitro study which suggests
that the agents inhibit replication of SARS-CoV-2.9
Reports for their benefits in patients come from 1
press release of a trial in China and 1 preprint case
series. Furthermore, Chinese research published in
February 2020 suggested the efficacy and safety of CQ
in treating pneumonia associated with COVID-19.5 A
subsequent Chinese study involving the use of both
CQ and HCQ determined that HCQ is the more
potent of these 2 drugs in its inhibition of this SARSCoV-2 in vitro.9 These results correlate with a recent
clinical study from France6; however, the evidence is
still speculative and the drugs have safety concerns.
These opinions based on scanty data created flimsy
hope, which garnered a lot of international attention in
this desperate situation. The widespread uproar over the
use of these drugs, the click bait information, and the
shockwaves sent by the President of the United States
have created scientific controversy and the discussion is
continued in the media.
The basis for the recent enthusiasm regarding
efficacy and clinical effectiveness HCQ and CQ
in COVID-19 have attracted press and public
attention and led the people to self-medicate with
these drugs.
Since sale of drugs is unregulated in the developing
countries in general and Pakistan in particular, there
might be an unsupervised use of these drugs by the general population, setting off a rush in off-label prescriptions which may lead to serious toxicities, an increase in
the number of hospital visits, and eventually ending up
1
2

Hayatabad Medical Complex, Peshawar, Pakistan
Paraplegic Centre Peshawar, Pakistan

Corresponding Author:
Iftikhar Ali, Paraplegic Centre, Sector P-1, Street 10, Phase-4, Hayatabad,
25100, Peshawar, Khyber Pakhtunkhwa, Pakistan.
Email: iftikharalijan@gmail.com
http://us.sagepub.com/en-us/journals-permissions http://dx.doi.org/10.1177/0018578720925387 http://journals.sagepub.com/home/hpx https://www.orcid.org/0000-0002-0809-7586 https://www.clinicaltrials.gov/ct2/results?cond=COVID-19 http://www.chictr.org.cn/abouten.aspx
Hospital Pharmacy - August 2020

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