The novel
severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes
coronavirus disease 2019 (COVID-19) and an ongoing severe pandemic. Curative drugs specific for
COVID-19 are currently lacking.
Chloroquine phosphate and its derivative
hydroxychloroquine, which have been used in the treatment and prevention of
malaria and
autoimmune diseases for decades, were found to inhibit
SARS-CoV-2 infection with high potency in vitro and have shown clinical and virologic benefits in
COVID-19 patients. Therefore,
chloroquine phosphate was first used in the treatment of
COVID-19 in China. Later, under a limited emergency-use authorization from the FDA,
hydroxychloroquine in combination with
azithromycin was used to treat
COVID-19 patients in the USA, although the mechanisms of the anti-COVID-19 effects remain unclear. Preliminary outcomes from clinical trials in several countries have generated controversial results. The desperation to control the pandemic overrode the concerns regarding the serious adverse effects of
chloroquine derivatives and combination drugs, including lethal arrhythmias and
cardiomyopathy. The risks of these treatments have become more complex as a result of findings that
COVID-19 is actually a multisystem disease. While respiratory symptoms are the major clinical manifestations,
cardiovascular abnormalities, including arrhythmias,
myocarditis,
heart failure, and
ischemic stroke, have been reported in a significant number of
COVID-19 patients. Patients with preexisting cardiovascular conditions (
hypertension, arrhythmias, etc.) are at increased risk of severe
COVID-19 and death. From pharmacological and cardiovascular perspectives, therefore, the treatment of
COVID-19 with
chloroquine and its derivatives should be systematically evaluated, and patients should be routinely monitored for cardiovascular conditions to prevent lethal adverse events.