Counterbalancing the Hydroxychloroquine Induced QT Prolongation: COVID 19 and Beyond

Those patients with progressive QT prolongation or QT interval exceeding >500 ms may complete the COVID 19 treatment protocol containing HCQ and/or AZM without serious arrhythmias and torsades de pointes by the adding the mexiletine or lidocaine as an adjunctive drug in those patients. Counterbalancing the QT prolongation by mexiletine in association with would further decrease the labor and stress of healthcare providers during the continuing COVID 19 pandemic. Although it is a big dilemma how the therapeutic or prophylactic use of HCQ will end up, the pathophysiologic effects of HCQ on QT interval and counterbalancing by antiarryhthmic drugs mexiletine and lidocaine is out of the current discussion of COVID 19 pandemics. Counter balancing effect of mexiletine and lidocaine on QT interval in patients receiving HCQ would be helpful in patients with not only COVID 19 but also in malaria and rheumatologic disease as well.