African countries need to consider implementing a prescription monitoring scheme to ensure their COVID-19 patients being treated with chloroquine and hydroxychloroquine are protected against the serious side effects associated with these drugs.
This is according to Professor Fatima Suleman, a professor in UKZN’s Discipline of Pharmaceutical Sciences and former Prince Claus Chair of Development and Equity at Utrecht University.
Suleman contributed to a perspective paper published in the journal American Society of Tropical Medicine and Hygiene, titled: Chloroquine and Hydroxychloroquine for the Prevention or Treatment of Novel Coronavirus Disease (COVID-19) in Africa: Caution for Inappropriate Off-Label Use in Healthcare Settings.
The paper is in response to the serious health risks the drugs pose if used as a treatment for patients who have not already benefitted from their use. These drugs are commonly used to treat patients with chronic illnesses such as rheumatoid arthritis and auto-immune conditions. The current mass panic buying of the drugs as a possible treatment for COVID-19 has led to a global shortage of the medication seriously impacting on those who rely on it.
Co-author, Professor Jean Nachega said: ‘Off-label use of chloroquine or hydroxychloroquine can cause abnormal heart rhythms, including ventricular tachycardia, and cardiac toxicity if either drug is used alone or combined with other medicines that are known to prolong the QT interval, such as azithromycin. Drug-drug interactions between chloroquine or hydroxychloroquine and medications for diseases that are common in Africa, like HIV and tuberculosis, can also, potentially, make the drugs ineffective or toxic.’
Suleman said the team of authors were advocating for pharmacists to dispense these medications with prescriptions for approved indications. ‘If doctors do prescribe these medications, they should have a monitoring system in place in the event of serious side effects and adverse events. As there are no proven, registered therapies for COVID-19, doctors must keep abreast of the literature to examine outcomes from other practices and countries so that, if serious effects are discovered and published, the therapy can be stopped immediately for other patients’, said Suleman.
Suleman also advocates for educational webinars in Africa to educate people on the serious side effects associated with use of these drugs, especially without supervision by doctors. Suleman also emphasised the need for a “collaborative network” in Africa to ensure co-ordinated production, distribution and post-marketing surveillance of any approved COVID-19 drug that aligns with low-cost distribution.
Words: MaryAnn Francis