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Call to protect African countries amid inappropriate off-label use of drugs to treat COVID-19

Professor Fatima Suleman, a professor in UKZN's Discipline of Pharmaceutical Sciences and former Prince Claus Chair of Development and Equity at Utrecht University, said African countries must consider implementing a prescription monitoring scheme to ensure that COVID-19 patients who are being treated with chloroquine and hydroxychloroquine are protected against serious side-effects associated with these drugs.

Suleman contributed to a perspective paper that was published in the American Society of Tropical Medicine and Hygiene, titled: 'Chloroquine and Hydroxychloroquine for the Prevention or Treatment of Novel Coronavirus Disease (COVID-19) in Africa: Caution for Inappropriate off Label Use in Healthcare Settings'.

The paper is in response to the serious health risks these drugs pose if it is used as a treatment on patients other than those its efficacy has already been proven on. These drugs are commonly used to treat patients with chronic illnesses such as rheumatoid arthritis and autoimmune conditions. Currently, the mass panic buying of the drugs as a possible treatment for COVID-19 has led to a global shortage of the medication, seriously impacting on those who rely on it.

Co-author Professor Jean Nachega said: "Off-label use of chloroquine or hydroxychloroquine can cause abnormal heart rhythms, including ventricular tachycardia and cardiac toxicity if either drug is used alone or combined with other medicines that are known to prolong the QT interval, such as azithromycin. Drug-drug interactions between chloroquine or hydroxychloroquine and medications for diseases that are common in Africa, like HIV and tuberculosis, can also, potentially, make the drugs ineffective or toxic."

Suleman said the team of authors are advocating for pharmacists to dispense these medications with prescriptions for approved indications. "If doctors do prescribe these medications, they should have a monitoring system in place in the event of serious side-effects and adverse events. As there are no proven, registered therapies for COVID-19, doctors must keep abreast of the literature to look at outcomes from other practices and countries so that, if serious effects are discovered and published, the therapy can be stopped immediately for other patients," said Suleman.

Suleman also advocates for educational Webinars in Africa to educate people on the serious side-effects of the use of these drugs especially without doctor's supervision. Suleman also emphasised that there is a need for a "collaborative network" in Africa to ensure co-ordinated production, distribution and post-marketing surveillance of any approved COVID-19 drug that aligns with low-cost distribution.