Patients infected with a resistant strains of plasmodia should be treated with another antimalarial drug. It suppresses malaria infection, stops acute attacks, and lengthens enough time between treatment and relapse. Chloroquine crosses the placenta and is also within low levels in breast milk, so pregnancy and lactation are often listed as contraindications to its use (see DermNet NZ’s pages on Safety of medicines taken during pregnancy and on Lactation and your skin). However, effects on the fetus and baby have been rarely reported and chloroquine has been continued during pregnancy and lactation when required for malaria.
Individuals who don’t have COVID-19 and who aren’t participating in a study or under the care of a medical provider shouldn’t take these medications as doing so may lead to serious health problems and might not exactly succeed in treating COVID-19 infection. It isn’t advisable to truly have a way to obtain these medications “just in case” as this might cause shortages for many who need these medications for ongoing medical conditions. Evidence before this study Before the CloroCovid-19 trial began, to our knowledge, there have been no published reports of robust clinical studies on the safety and/or efficacy of chloroquine and/or hydroxychloroquine for the treating COVID-19 during the recent 2020 pandemic. We found no published studies comparing different dosages of CQ/HCQ and their thorough safety assessment. Drugs used for other diseases were tried out in COVID-19, and this included chloroquine, used for malaria; and hydroxychloroquine used for rheumatic diseases, such as rheumatoid arthritis or systemic lupus erythematosus. The authors sought proof the effects of these drugs in treating people ill with the disease; in preventing the disease in people at risk of getting the condition, such as health workers; and people exposed to the virus developing the condition.
Hypokalemia is an important manifestation of chloroquine poisoning and a contributor to tachyarrhythmias (Clemessy et al., 1995). With high dose regimens plasma potassium concentrations should be maintained over 4.0 mmol/L and plasma magnesium concentrations over 0.8 mmol/L. Overall treatment regimens for hospitalised COVID-19 patients which lead to whole blood chloroquine concentrations below 10 µmol/L for more than 95% of patients have an acceptable safety margin. As chloroquine has relatively weak antiviral activity, if there is benefit in COVID-19 infections, it is likely to require high drug exposures.
Panel C shows the predicted mortality per thousand for the six regimens as a function of bodyweight. Pharmacokinetic-pharmacodynamic style of chloroquine induced mortality under the plasma pharmacokinetic style of chloroquine. Predicted Cmax distributions for a 70 kg adult for the plasma pharmacokinetic model and the whole blood pharmacokinetic model under the six different regimens. Between-patient variability, 30%, was added exponentially in every parameters. Relationship between whole-blood concentrations of chloroquine + desethyl metabolite (μM) measured by UV-spectrophotometry on admission in self-poisoning, and outcome. Chloroquine has been formulated as sulphate, phosphate, and hydrochloride salts which is recommended for malaria in weights of base content .
However, the prevalence of bacterial co-infection and secondary bacterial infection in patients with COVID-19 appears to be relatively low. The prevalence of secondary transmissions is higher in patients with severe COVID-19 who are hospitalised and/or mechanically ventilated than in other patients [61-63] . On the other hand, there is dependence on more clarity in defining secondary transmissions in COVID-19 patients .
Note that the Emax regression model does not take into account concentration-dependent heteroskedasticity but only inter-individual variation for healthy volunteers and inter-study variation . Whole-blood exposure and peak concentrations at different body weights (40-90 kg) were simulated utilizing a weight-based loading dose of 3 to 5 tablets followed by a set maintenance dose of one tablet daily for 3 months. These show expected exposures, as with the treatment of rheumatological conditions, which are well below those associated with cardiovascular safety concerns, though it remains to be observed if these levels are effective in preventing COVID-19.