key: cord-0871368-jobd5s4l
authors: Tulgar, Serkan; Ahıskalıoğlu, Ali; Kök, Abdulaziz; Thomas, David Terence
title: Possible Old Drugs for Repositioning in COVID-19 Treatment: Combating Cytokine Storms from Haloperidol to Anti-interleukin Agents
date: 2019-06-01
journal: Turk J Anaesthesiol Reanim
DOI: 10.5152/tjar.2020.662
sha: 2a1ce8ab15396763724c23bd64544a14216cbdc8
doc_id: 871368
cord_uid: jobd5s4l

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Until recently, haloperidol was the most commonly used agent in the prevention or treatment of delirium that developed in intensive care units (9, 10) . Herein, we would like to consider a completely different purpose for its use. In 2005, Milbrandt et al. (11) reported that haloperidol decreased mortality of patients on mechanical ventilation and hypothesized that this was due to its effect on lowering cytokine levels and, therefore, aided in preventing a cytokine storm associated with severe disease. In line with this data, although certain texts claim the opposite, the hypothesis that haloperidol has inhibitory effects on proinflammatory cytokines may be an essential step in preventing the progression of the disease and reducing its severity. We accept that there is no certainty to recommend starting haloperidol for every patient diagnosed with COVID-19 whose treatment had commenced. However, we recommend that haloperidol be considered as an option to treat patients who develop agitation during the treatment process or agitation/delirium during the intensive care treatment process and continue to be administered routinely until proven otherwise. Of course, drug interactions must be considered.

There is still insufficient evidence for the use of either tocilizumab or other treatment agents in the treatment of COVID-19. Tocilizumab is available as an effective option in combating cytokine storm. However, this drug is not readily available all over the world. Therefore, different options must be sought, and alternatives must be put forward.

Our current strategy is to gain time by using existing drugs outside of their known indications until a definitive treatment or vaccine is found in the treatment of COVID-19. In addition to clinical studies (NCT04330638) related to the use of anti-IL agents such as anakinra, siltuximab, and tocilizumab in combating cytokine storms, studies are also being conducted with old drugs (NCT04304313) such as sildenafil, used indirectly outside of their indications. Haloperidol should also be the subject of a similar study as soon as possible.

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