COVID-19: Therapeutics and Their Toxicities

doi:10.1007/s13181-020-00777-5

Review

. 2020 Jul;16(3):284-294.

doi: 10.1007/s13181-020-00777-5. Epub 2020 Apr 30.

COVID-19: Therapeutics and Their Toxicities

Michael A Chary^{1

2

3}, Alexander F Barbuto^{4

5

6}, Sudeh Izadmehr⁷, Bryan D Hayes⁸, Michele M Burns^{4

5}

Affiliations

¹ Division of Emergency Medicine, Harvard Medical Toxicology Fellowship, Boston Children's Hospital, Boston, MA, USA. michael.chary@childrens.harvard.edu.
² Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA. michael.chary@childrens.harvard.edu.
³ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA. michael.chary@childrens.harvard.edu.
⁴ Division of Emergency Medicine, Harvard Medical Toxicology Fellowship, Boston Children's Hospital, Boston, MA, USA.
⁵ Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA.
⁶ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁷ Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁸ Department of Pharmacy, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.

PMID: 32356252
PMCID: PMC7192319
DOI: 10.1007/s13181-020-00777-5

Review

COVID-19: Therapeutics and Their Toxicities

Michael A Chary et al. J Med Toxicol. 2020 Jul.

. 2020 Jul;16(3):284-294.

doi: 10.1007/s13181-020-00777-5. Epub 2020 Apr 30.

Authors

Michael A Chary^{1

2

3}, Alexander F Barbuto^{4

5

6}, Sudeh Izadmehr⁷, Bryan D Hayes⁸, Michele M Burns^{4

5}

Affiliations

¹ Division of Emergency Medicine, Harvard Medical Toxicology Fellowship, Boston Children's Hospital, Boston, MA, USA. michael.chary@childrens.harvard.edu.
² Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA. michael.chary@childrens.harvard.edu.
³ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA. michael.chary@childrens.harvard.edu.
⁴ Division of Emergency Medicine, Harvard Medical Toxicology Fellowship, Boston Children's Hospital, Boston, MA, USA.
⁵ Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA.
⁶ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁷ Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁸ Department of Pharmacy, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.

PMID: 32356252
PMCID: PMC7192319
DOI: 10.1007/s13181-020-00777-5

Abstract

SARS-CoV-2 is a novel coronavirus that emerged in 2019 and is causing the COVID-19 pandemic. There is no current standard of care. Clinicians need to be mindful of the toxicity of a wide variety of possibly unfamiliar substances being tested or repurposed to treat COVID-19. The United States Food and Drug Administration (FDA) has provided emergency authorization for the use of chloroquine and hydroxychloroquine. These two medications may precipitate ventricular dysrhythmias, necessitating cardiac and electrolyte monitoring, and in severe cases, treatment with epinephrine and high-doses of diazepam. Recombinant protein therapeutics may cause serum sickness or immune complex deposition. Nucleic acid vaccines may introduce mutations into the human genome. ACE inhibitors and ibuprofen have been suggested to exacerbate the pathogenesis of COVID-19. Here, we review the use, mechanism of action, and toxicity of proposed COVID-19 therapeutics.

Keywords: COVID-19; Pandemic; SARS-CoV-2; Therapeutic; Toxicity.

PubMed Disclaimer

Conflict of interest statement

Dr. Burns is the Pediatric Toxicology Section Editor for UpToDate. No other authors report conflicts of interest.

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References

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1. Zeng JH, Liu YX, Yuan J, Wang FX, Wu WB, Li JX, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection. 2020 Apr 10. doi: 10.1007/s15010-020-01424-5. - PMC - PubMed
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[1] Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020 Feb 24. doi: 10.1016/S2213-2600(20)30079-5. - PMC - PubMed

[2] Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020 Feb 24. doi: 10.1016/S2213-2600(20)30079-5. - PMC - PubMed

[3] Ñamendys-Silva SA. Respiratory support for patients with COVID-19 infection. Lancet Respir Med. 2020 Apr;8(4):e18. - PMC - PubMed

[4] Ñamendys-Silva SA. Respiratory support for patients with COVID-19 infection. Lancet Respir Med. 2020 Apr;8(4):e18. - PMC - PubMed

[5] Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020 Mar 28;395(10229):1033–1034. - PMC - PubMed

[6] Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020 Mar 28;395(10229):1033–1034. - PMC - PubMed

[7] Zeng JH, Liu YX, Yuan J, Wang FX, Wu WB, Li JX, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection. 2020 Apr 10. doi: 10.1007/s15010-020-01424-5. - PMC - PubMed

[8] Zeng JH, Liu YX, Yuan J, Wang FX, Wu WB, Li JX, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection. 2020 Apr 10. doi: 10.1007/s15010-020-01424-5. - PMC - PubMed

[9] Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020 Mar 5. doi: 10.1038/s41569-020-0360-5. - PMC - PubMed

[10] Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020 Mar 5. doi: 10.1038/s41569-020-0360-5. - PMC - PubMed

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COVID-19: Therapeutics and Their Toxicities

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COVID-19: Therapeutics and Their Toxicities

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