Analysis of possible intoxications resulting from the indiscriminate use of ivermectin and hydroxychloroquine during the COVID-19 pandemic

Authors

DOI:

https://doi.org/10.33448/rsd-v11i3.26441

Keywords:

Ivermectin; Hydroxychloroquine; COVID-19; Intoxication.

Abstract

Introduction: In late December 2019, there was an outbreak of an emerging disease (COVID-19) due to a new coronavirus, called SARS-CoV-2, which started in Wuhan, China, spreading globally as a pandemic. The critical scenario imposed by has driven the search for therapeutic and prophylactic pharmacological strategies, such as ivermectin and hydroxychloroquine. Objective: to highlight, through empirical and current analyses, the risks associated with the indiscriminate use of ivermectin and hydroxychloroquine as therapeutics against COVID-19, highlighting the toxicity effects of these drugs. Methodology: this is a descriptive research of the integrative literature review type. The research was carried out through online access to the National Library of Medicine (PubMed MEDLINE), Scientific Electronic Library Online (Scielo), Cochrane Database of Systematic Reviews (CDSR), Google Scholar, Virtual Health Library (BVS) and EBSCO databases. Information Services, in August 2021. Results and discussion: according to ANVISA, there are still no conclusive studies that accept the hypothesis that ivermectin is effective in the treatment of COVID-19. As for hydroxychloroquine, in relation to its mechanism of action, hydroxychloroquine is believed to act, under COVID-19 infection, by preventing terminal glycosylation of the ACE2 enzyme, which, in turn, acts as a membrane receptor for SARS- CoV-2, which can then prevent the virus from binding. However, there is still no dispute about the effectiveness of these drugs under COVID-19, and there are even reports of organic toxicity related to the indiscriminate use of these drugs, associated with problems such as bleeding, renal failure, arrhythmias and even drug hepatitis. Final considerations: the role of the physician and, even more, the clinical pharmacist, is of paramount importance, which goes beyond the pharmacotherapeutic follow-up to patients who use polypharmacy.

References

Axfors, C., et al. (2021). Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nat Commun, 12 (2349), 1-9.

Barbosa, J., et al. (2020). Outcomes of Hydroxychloroquine in Hospitalized Patients with COVID-19: A Quasi-Randomized Comparative Study. N Engl J Med, 7 (6), 21-25.

Batista T. A. B., et al. (2021). Clinical implications and cardiotoxicity in hydroxychloroquine overdose. Revinter, 14 (2), 29-35.

Borba, M. G. S., et al. (2020). Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCOVID-19 Study). MedRxiv.

Brasil. Agência Nacional de Vigilância Sanitária (ANVISA). Nota de esclarecimento sobre a ivermectina. 2020.

Broeke, R. T., et al. (2016). Early treatment with intravenous lipid emulsion in a potentially lethal hydroxychloroquine intoxication. Neth J Med, 74 (5), 210-214.

Caly, L., et al. (2020). O medicamento aprovado pela FDA ivermectina inibe a replicação do SARS-CoV-2 in vitro. Elsevier, 178 (104), 1-7.

Cavalcanti, A. B., et al. (2020). Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate COVID-19. N Engl J Med, 383 (11), 2041-2052.

Chaves, E.F. et al. (2020). Considerações sobre os medicamentos com potencial efeito farmacológico para o vírus SARS-HCoV-2. Departamento de Farmácia – AMIB.

Chen, J., et al. (2020). A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19). J Zhejiang Univ (Med Sci), 49 (2), 24-31.

Chen, Z., et al. (2020). Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial. MedRxiv.

Duan, Y. J., et al. (2020). The Trial of Chloroquine in the Treatment of Corona Virus Disease 2019 (COVID-19) and Its Research Progress in Forensic Toxicology. Fa Yi Xue Za Zhi, 36 (2), 34-38.

Fantini J., et al. (2020). Estudos de modelagem estrutural e molecular revelam um novo mecanismo de ação da cloroquina e hidroxicloroquina contra a infecção por SARS-CoV-2. International Journal of Antimicrobial Agents, 1 (8), 56-63.

Ferner, R. E., et al. (2020). Chloroquine and hydroxychloroquine in COVID-19. BMJ, 369 (1432), 1-7.

Gautret, P., et al. (2021). Effect of hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial, an update with an intention-to-treat analysis and clinical outcomes. Int J Antimicrob Agents, 57 (1).

Gautret P., et al. (2020). Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents, 56 (1), 724-731.

Gonzalez, B. J., et al. (2021). Eficácia e segurança de ivermectina e hidroxicloroquina em pacientes com COVID-19 grave. Um ensaio clínico randomizado. Medrix.

Lacava, A. C. (2010). Complicações oculares da terapêutica com a cloroquina e derivados. Arquivos Brasileiros de Oftalmologia, 73 (4), 384-389.

Lima, W. G., et al. (2020). Uso irracional de medicamentos e plantas medicinais contra a COVID-19 (SARS-CoV-2): Um problema emergente. Brazilian Journal of Health and Pharmacy, 2 (3), 37-53.

Mcbeth, P. B., et al. (2015). Novel therapies for myocardial irritability following extreme hydroxychloroquine toxicity. Case Reports in Emergency Medicine, 87 (6), 1-6.

Melo, P. A., et al. (2020). Do ponto de vista farmacológico, o uso da ivermectina poderia ser eficaz frente à infecção por COVID-19? Uma revisão bibliográfica. Almanaque Multidisciplinar de Pesquisa, 7 (2), 98-100.

Menezes C. R., et al. (2020). Effectiveness and toxicity of chloroquine and hydroxychloroquine associated (or not) with azithromycin for the treatment of COVID-19. What do we know so far? J. Health Biol Sci., 8 (1), 1-9.

Merino, A., et al. (2017). Hydroxychloroquine, a potentially lethal drug. Medicina Intensiva, 41 (4).

Mitjà, O., et al. (2021). A Cluster-Randomized Trial of Hydroxychloroquine for Prevention of COVID-19. N Engl J Med, 384 (2), 417-427.

Olano, J., et al. (2019). Toxicokinetics of hydroxychloroquine following a massive overdose. The American Journal of Emergency Medicine, 37 (12).

Pacheco, T. J. A., et al. (2020). Panorama mundial de estudos com a hidroxicloroquina para o tratamento da COVID-19. Journal of Health & Biological Sciences, 8 (1), 34-41.

Patrì, A., et al. (2020). Hydroxychloroquine and ivermectin: A synergistic combination for COVID-19 chemoprophylaxis and treatment? Journal of the American Academy of Dermatology, 82 (6).

Pedroso, L. A., et al. (2020). Aspectos farmacológicos da ivermectina e seu potencial uso no tratamento da COVID-19. Brazilian Journal of Health and Pharmacy, 2 (3), 76-81.

Popp, M., et al. (2021). Ivermectina para prevenir e tratar COVID ‐ 19. Cochrane Database of Systematic Reviews, 7 (1), 87-91.

Saag, M. S., et al. (2020). Misguided Use of Hydroxychloroquine for COVID-19: The Infusion of Politics into Science. JAMA, 324 (1), 2161-2162.

Singh, B., et al. (2021). Chloroquine or hydroxychloroquine for prevention and treatment of COVID-19. Cochrane Database Syst Rev, 2 (13587), 43-47.

WHO Solidarity Trial Consortium. (2021). Repurposed Antiviral Drugs for COVID-19 - Interim WHO Solidarity Trial Results. N Engl J Med, 384 (87), 497-511.

Zhou, D., et al. (2020). COVID-19: a recommendation to examine the effect of hydroxychloroquine in preventing infection and progression, J Antimicr Chemotherapy, 75 (7), 1667-1670.

Published

16/02/2022

How to Cite

FIGUEIREDO, B. Q. de .; CANCELA, B. R.; RODRIGUES, A. E. L.; FALCÃO, A. L. S.; PRADO, D. M. M. do .; ROCHA, D. da .; LIMA, I. C. de M.; SILVA SEGUNDO, R. J. e . Analysis of possible intoxications resulting from the indiscriminate use of ivermectin and hydroxychloroquine during the COVID-19 pandemic. Research, Society and Development, [S. l.], v. 11, n. 3, p. e14511326441, 2022. DOI: 10.33448/rsd-v11i3.26441. Disponível em: https://www.rsdjournal.org/index.php/rsd/article/view/26441. Acesso em: 25 apr. 2024.

Issue

Section

Health Sciences