key: cord-1043248-rkkb9yxa
authors: Ghosh, Abhishek; Roub, Fazle; Bisaga, Adam
title: Drug treatment of SARS-Cov2: Potential effects in patients with substance use disorders (SUD)
date: 2020-05-22
journal: J Psychosom Res
DOI: 10.1016/j.jpsychores.2020.110159
sha: 0128a0d67a38d21a3ed8c90108b7fa2eea555775
doc_id: 1043248
cord_uid: rkkb9yxa

nan

Severe acute respiratory syndrome-Coronavirus 2 (SARS-CoV2) has presented an unprecedented challenge of finding therapeutic agents. Presently hydroxychloroquine (HCQ), lopinavir-ritonavir combination (LR), remdesivir, and favipiravir are candidate medications. Patients with substance use disorder (SUD) are especially susceptible to develop COVID-19 owing to underlying comorbidities, immune-suppression, and socioeconomic circumstances of drug use [1] . Moreover, the SARS-CoV2 pandemic has met with a pre-existing epidemic of Opioid use disorders. Given the susceptibility and magnitude of both the conditions, co-occurrence seems to be commonplace. Therefore, exploring the effects of candidate medications (for SARS-CoV2) among patients with SUD warrant clinical attention.

HCQ may lower seizure threshold with reports of tonic-clonic seizures among patients with systemic lupus [2] . Abruptly stopping alcohol use may lower seizure threshold warranting caution before starting HCQ. Both alcohol and HCQ may affect proximal muscles and peripheral nerves, hence patients with alcohol-induced neuro-myopathy need close monitoring, especially those with comorbid hepatic dysfunctions [3] . HCQ, azithromycin combination, are arrhythmogenic, and co-administration of methadone may increase the risk of QT C prolongation [4] . Hence close ECG monitoring is advisable. Moreover, methadone and HCQ are substrates for CYP2D6 and CYP3A4a; methadone's serum level may increase with resultant risk of overdose. Tobacco smokers had lower HCQ response rates (in malaria)

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