Drug General Information (ID: DDIBD4CQA0)
Drug Name			Chloroquine		Drug Info		Fostemsavir		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antimalarial Agents				Antiviral Agents
Structure

Mechanism of Chloroquine-Fostemsavir Interaction (Severity Level: Major)
Increased risk of prolong QT interval Click to Show/Hide Mechanism Graph
Drug Name		Chloroquine				Fostemsavir
Mechanism		Prolong QT interval				Prolong QT interval
Key Mechanism Factor 1
		Factor Name		QT interval
		Factor Description		Long QT syndrome is a heart signaling disorder that can cause a fast, chaotic heartbeat (arrhythmia). Many people may not exhibit symptoms, and usually the condition is detected during routine medical tests. In others, the most common symptoms include: sudden fainting, palpitations, dizziness, seizures, sudden death.
Mechanism Description		Increased risk of prolong QT interval by the combination of Chloroquine and Fostemsavir

Recommended Action
Management		Coadministration of chloroquine or hydroxychloroquine with other drugs that can prolong the QT interval should generally be avoided, particularly in patients with baseline QT prolongation (e.g., QTc >=500 msec) or congenital long QT syndrome. Close monitoring of QTc interval, electrolyte levels, and renal and hepatic function is recommended if concomitant use is required and benefits are anticipated to outweigh the risks. Electrolyte abnormalities should be corrected prior to initiating treatment with chloroquine or hydroxychloroquine. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope. Because chloroquine and hydroxychloroquine are eliminated slowly from the body, the potential for drug interactions should be observed for a prolonged period following their discontinuation.

References
1	Harper KM, Knapp DJ, Criswell HE, Breese GR "Vasopressin and alcohol: A multifaceted relationship." Psychopharmacology (Berl) 235 (2018): 3363-79. [PMID: 32936259]
2	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
3	Javelot H, El-Hage W, Meyer G, Becker G, Michel B, Hingray C "COVID-19 and (hydroxy)chloroquine-azithromycin combination: should we take the risk for our patients?" Br J Clin Pharmacol Apr 29 (2020): epub ahead of print. [PMID: 32350872]
4	National Institutes of Health (NIH) "Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.".
5	Product Information. Chloroquine Phosphate (chloroquine). West-Ward Pharmaceutical Corporation, Eatontown, NJ.
6	Product Information. Hydroxychloroquine Sulfate (hydroxychloroquine). Prasco Laboratories, Cincinnati, OH.
7	Product Information. Plaquenil (R). (hydroxychloroquine). Sanofi Winthrop Pharmaceuticals, New York, NY.
8	Roden DM, Harrington RA, Poppas A, Russo AM "Considerations for drug interactions on QTc in exploratory COVID-19 (Coroanvirus disease 2019) treatment." Heart Rhythm Apr 14 (2020): epub ahead of print. [PMID: 32302703]
9	Sacher F, Fauchier L, Boveda S, et.al "Use of drugs with potential cardiac effect in the setting of SARS-CoV-2 infection." Arch Cardiovasc Dis Apr 24 (2020): epub ahead of print. [PMID: 32354666]
10	Saleh M, Gabriels J, ChangD, et.al "The effect of chloroquine, hydroxychloroquine and azithromycin on the corrected QT interval in patients with SARS-CoV-2 infection." Circ Arrhythm Electrophysiol Apr 29 (2020): epub ahead of print. [PMID: 32347743]
11	Sapp JL, Alqarawi W, MacIntyre CJ, et.al "Guidance on minimizing risk of drug-induced ventricular arrhythmia during treatment of COVID-19: A statement from the Canadian Heart Rhythm Society." Can J Cardiol Apr 8 (2020): epub ahead of print. [PMID: 32299753]
12	Smit C, Peeters MYM, van den Anker JN, Knibbe CAJ "Chloroquine for SARS-CoV-2: Implications of its unique pharmacokinetic and safety properties." Clin Pharmacokinet Ar 18 (2020): epub ahead of print. [PMID: 32306288]
13	Bessiere F, Roccia H, Deliniere A, et.al "Assessment of QT intervals in a case series of patients with coronavirus disease 2019 (COVID-19) infection treated with hydroxychloroquine alone or in combination with azithromycin in an intensive care unit." JAMA Cardiol May 1 (2020): epub ahead of print. [PMID: 32936266]
14	Borba MGS, Val FFA, Sampaio VS, et.al "Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with severe acute respiratory syndrome coronavirus 1 (SARS-CoV-2) infection: A randomized clinical trial." JAMA Netw Open Apr 1 (2020): epub ahead of print. [PMID: 32330277]
15	Giudicessi JR, Noseworthy PA, Friedman PA, Ackerman MJ "Urgent guidance for navigating and circumventing the QTc-prolonging and torsadogenic potential of possible pharmacotherapies for coronavirus disease 19 (COVID-19)" Mayo Clin Proc Apr 7 (2020): epub ahead of print. [PMID: 32359771]
16	Kapoor A, Pandurangi U, Arora V, et.al "Cardiovascular risks of hydroxychloroquine in treatment and prophylaxis of COVID-19 patients: A scientific statement from the Indian Heart Rhythm Society." Indian Pacing Electorphysiol J Apr 8 (2020): epub ahead of print. [PMID: 32278018]
17	Mercuro NJ, Yen CF, Shim DJ, et.al "Risk of QT interval prolongation associated with the use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus disease 2019 (COVID-19)" JAMA Cardiol May 1:e201834 (2020): epub ahead of print. [PMID: 32936252]
18	mitra RL, Greenstein SA, Epstein lm "An algorithm for managing QT prolongation in coronavirus disease 2019 (COVID-19) patients treated with either chloroquine or hydroxychloroquine in conjunction with azithromycin Possible benefits of intravenous lidocaine." HeartRythm Case Rep Apr 1 (2020): epub ahead of print. [PMID: 32363145]
19	US Food and Drug Administration "FACT SHEET FOR HEALTH CARE PROVIDERS EMERGENCY USE AUTHORIZATION (EUA) OF CHLOROQUINE PHOSPHATE SUPPLIED FROM THE STRATEGIC NATIONAL STOCKPILE FOR TREATMENT OF COVID-19 IN CERTAIN HOSPITALIZED PATIENTS. Available from: URL: https://www.fda.gov/media/13653" ([2020, Apr 27]):.
20	US Food and Drug Administration "Hydroxychloroquine or Chloroquine for COVID-19: Drug Safety Communication - FDA Cautions Against Use Outside of the Hospital Setting or a Clinical Trial Due to Risk of Heart Rhythm Problems.".