key: cord-0953348-pfmsweeo
authors: Tecen‐Yucel, Kamer; Aras‐Atik, Elif; Bayraktar‐Ekincioglu, Aygin
title: Does therapeutic drug monitoring of hydroxychloroquine improve treatment outcome in intensive care unit patients with COVID‐19?
date: 2021-03-19
journal: Int J Clin Pract
DOI: 10.1111/ijcp.13894
sha: 64b1059122b094e83c251d881aa068f680e0987d
doc_id: 953348
cord_uid: pfmsweeo

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Patients in intensive care unit (ICU) present certain characteristics such as presence of sepsis, obesity, extracorporeal membrane oxygenation that may cause an increase in the volume of distribution of drugs. 3 The presence of these factors may prevent to achieve the desired concentration of HCQ in this special population.

There is little information about the efficacy of HCQ and modalities of administration of this drug in ICU patients with COVID-19.

The therapeutic level of HCQ in patients with COVID-19 has not yet been established. According to the studies, HCQ trough levels between 1-2 mg/L were considered to be therapeutic. 4 The most commonly seen adverse effect of HCQ in patients with COVID-19 is cardiac toxicity. The relation between cardiac toxicity and HCQ concentration has not been determined; however, it is known that HCQ concentration should not exceed 2 mg/L in order to avoid ocular toxicity. 8 In Perinel et al study, two patients experienced cardiac toxicity at high HCQ concentrations. Although a high dose of HCQ is given initially during the COVID-19 treatment, it should be remembered that a high drug exposure is likely to cause unwanted effects in vulnerable patients at critical circumstances, therefore therapeutic drug monitoring of HCQ may reduce the risk of its occurrence.

In addition, the day of HCQ initiation during the COVID-19 infection was not indicated in the study by Perinel et al 2 As it known that liver and kidney functions can be damaged in patients in ICU which may result in delays in reaching the therapeutic drug concentration and increase the risk of adverse drug reactions, particularly in patients with COVID-19. 9, 10 Existence of high mortality rates in the ICU and uncertainty around reaching the therapeutic concentration, we suggest that individual dose modification by therapeutic drug monitoring for HCQ until its concentration reaches the therapeutic level (mean duration of 3-4 days) in ICU patients with COVID-19 can help to achieve optimal outcomes and reduce the risk of drug interactions. Further pharmacokinetic and pharmacodynamic (virological) studies are also warranted.

None.

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