Hydroxychloroquine/Azithromycin combination and QTc, an expert recommendation

Quality of evidence: D-

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Considerations for Drug Interactions on QTc in Exploratory COVID-19 (Coronavirus Disease 2019) Treatment

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Authors: The root et al.

Journal: Circulation

Objectives: Provide considerations for changes in QT interval related to the combined treatment of hydroxychloroquine and azithromycin

Strength of evidence: D- (expert recommendation, limited relevant sources)

Methods/publication type: Expert recommendation

Highlights :

• Taken individually, the two drugs can cause a prolongation of the QT interval and torsade de pointe

• Case reports suggest torsade de pointe in subjects treated with hydroxychloroquine for lupus erythematosus

• Intensive use of azithromycin linked to arrhythmia, to increased risk of sudden death, prolongation of the QT interval (old age and the female sex = risk factors)

Necessary precaution if using this combination :

• Don't use on in subjects with long QT syndrome

• Monitor electrocardiogram and QT interval

• Discontinue treatment if the QTc interval> 500 msec

• Avoid the administration of other drugs inducing QT prolongation

• Adjust hypokalemia up to > 4 mEq/L and of hypomagnesemia up to > 2mg/dL

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