Quality of evidence: D-
Considerations for Drug Interactions on QTc in Exploratory COVID-19 (Coronavirus Disease 2019) Treatment
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
