Possible Drug-Drug Interactions of Hydroxychloroquine with Concomitant Medications in Prophylaxis and Treatment of COVID-19: Multiple Standard Software Based Assessment
P Ansuman Abhisek,
Senior Resident/Tutor, Department of Pharmacology, MKCGMCH, Shanti Nagar, Berhampur-760004, Odisha, India.
Introduction: It is a crucial time for the medical community to cope up with novel Coronavirus Disease 2019 (COVID-19). The empirical evidence for the effectiveness of Hydroxychloroquine (HCQ) in COVID-19 is currently very limited. So in this context, it is very important to counter Drug-Drug Interactions (DDIs).
Aim: To assess, compare and compile DDIs of HCQ with other medications and their risk management. Software databases like Lexicomp, drugs.com DDI checker and Medscape DDI checker were utilised to obtain various spectrum of DDIs.
Materials and Methods: The study was undertaken in Department of Pharmacology from 31st March 2020 to 30th April 2020, in a Tertiary Care Teaching Hospital in Eastern India. This was an observational, software-based study. LexicompÂ® drug Interactions software was the baseline software, used to access the details of DDIs of HCQ like severity, adverse effects, types of DDIs, risk management of DDIs and their reliability. Drugs. com and Medscape interaction checkers were used to compare details of DDIs obtained from Lexicomp. Spearmanâ€™s rank order correlation and reliability (cohenâ€™s kappa) of the data obtained from the three software programs were analysed.
Results: Total number of DDIs of HCQ with individual drugs were found to be 279. Among these DDIs of individual drugs, maximum had risk rating of C (66.66%). The adverse effect that was maximum reported in Lexicomp was changes in glycaemic control whereas Medscape and drugs.com software programs showed QT prolongation. Considering Lexicomp as standard, the correlation with Medscape and Drugs.com interaction checker software programs were -0.257 (weakly negative) and -0.359 (moderately negative), respectively. When Medscape and drugs.com were compared, both showed strong positive correlation (r=0.716). Cohenâ€™s kappa between Lexicomp and Medscape, Lexicomp and drugs.com, Medscape and drugs. com were 0.011 (slightly reliable), 0.004 (poorly reliable), 0.568 (moderately reliable), respectively.
Conclusion: There is a need to improve knowledge and awareness amongst the treating physicians and the healthcare professionals of HCQ related DDIs in the higher risk cases especially related to COVID-19 or for prophylaxis and/or other. It was observed that Lexicomp software is better in assessing DDIs of HCQ as compared to other two software programs.