Hydroxychloroquine

Author Information

An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

In a case report, 3 patients (1 woman and 2 men) aged 61−74 years were described, who developed hypoglycaemia during off-label treatment with hydroxychloroquine for COVID-19 [routes not stated].

Case 1: A 64-year-old woman, who had end-stage kidney disease secondary to hypertensive nephrosclerosis and a history of failed kidney transplantation, was receiving haemodialysis. She was hospitalised due to fever. Her previous HbA1c level measured 15 days ago was 5.4%. Subsequently, she was diagnosed with COVID-19, and started receiving off-label treatment with oseltamivir, azithromycin and hydroxychloroquine. Additionally, she received unspecified low molecular weight heparins with several other co-medications. Hydroxychloroquine was administered at a dose of 400mg twice a day as loading dose on day 1, followed by a maintenance dose of 200mg twice a day for the next 4−9 days. On day 4 of hydroxychloroquine treatment, her fasting hypoglycaemia was noted with a serum glucose level of 50 mg/dL. She also developed stress-induced hypocortisolism. She was then treated with dextrose infusion from day 4−6 of hospitalisation along with methylprednisolone. However, there was insignificant response on the treatment. Her hydroxychloroquine treatment was stopped on day 5 of the treatment. Eventually, she was discharged on day 10 of hospitalisation without any complications.

Case 2: A 61-year-old man, who was on haemodialysis, was hospitalised due to cough and dyspnoea. A detailed devaluation led to the diagnosis of COVID-19, and he started receiving off-label treatment with oseltamivir, azithromycin and hydroxychloroquine. Additionally, he received unspecified low molecular weight heparins with several other co-medications. Hydroxychloroquine was administered at a dose of 400mg twice a day as a loading dose on day 1, followed by a maintenance dose of 200mg twice a day for the next 4−9 days. On day 3 of the treatment, his clinical condition worsened with fluctuating levels of consciousness, and he also developed pneumonia. His fasting blood glucose level was 52 mg/dL. Thus, he was treated with dextrose infusion. On day 4 of the treatment, he was shifted to the ICU for severe hypoxaemia. His hydroxychloroquine treatment was stopped on day 5 of treatment as he had hypoglycaemic episodes, while intermittent dextrose infusion was continued. His hypoglycaemia resolved following hydroxychloroquine discontinuation. On day 5 of the hospitalisation, he was intubated for severe COVID-19, and started receiving off-label favipiravir. However, he died due to severe COVID-19 infection on day 9 of the hospitalisation.

Case 3: A 74-year-old man, who was on haemodialysis, was admitted to the emergency department with a persistent cough since 2 days. At admission, his HbA1c was 5.2%. A detailed devaluation led to the diagnosis of COVID-19, and he started receiving off-label treatment with oseltamivir, azithromycin and hydroxychloroquine. Additionally, he received unspecified low molecular weight heparins with several other co-medications. Hydroxychloroquine was administered at a dose of 400mg twice a day as a loading dose on day 1, followed by a maintenance dose of 200mg twice a day for the next 4−9 days. On day 2 of the treatment, asymptomatic fasting hypoglycaemia was noted. However, his postprandial glucose levels were normal. Further, he developed hypoxaemia on day 5 of the treatment. Hence, off-label therapy with favipiravir was started for severe COVID-19. His hydroxychloroquine treatment was stopped as he developed hypoglycaemia. His hypoglycaemia resolved following hydroxychloroquine discontinuation until day 16 of discharge.