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Current Treatment of COVID 19 and a Look at Possible Drug Interactions

Severe acute respiratory syndrome coronavirus  Research continues unabated to develop a specific treatment against (SARS-CoV-2). In the current current treatment, extracorporeal membrane oxygenation (Oxygen and mechanical ventilation) supportive therapy as the first treatment for the elimination of infection in clinical treatment for critically ill patients due to the lack of therapeutic drug to be applied directly against SARS-CoV-2 may partially prevent the coronavirus pandemic.  

Although antivirals, antimalarials and biologics are used in supportive therapy, until the randomized clinical trials are completed in terms of the safety and continuity of the treatment, for the effectiveness of the available treatment options; Determining the benefits to be gained from the use of non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs) is a priority. Despite personal protective measures such as masks used to prevent the epidemic, distance and cleanliness, the transformation of coronavirus infection into a global disaster makes it the most urgent option to initiate an intensive pharmacological intervention (established drugs and vaccines) as soon as possible for effective drug treatment. 

Intensive attempts to investigate the prophylaxis and treatment of SARS-CoV-2 infection have been identified based on the different modes of action on the virus and the various routes through which it is passed: 

¬ Antiviral (Lopinavir / Ritonavir Combination, Remdesivir And Favipiravir), 
¬ Antimalarials (Chloroquine and Hydroxychloroquine), 
¬ ACE2 Inhibitor (Losartan),
¬ Immunosuppressive Agents (Tokilizumab, Leronlimab and Corticosteroids), 
¬ TMPRSS2 Inhibitor (Kamostat Mesylate),
¬ Anti-Parasitic Drugs (Ivermectin and Nitazoxanide),
¬ An Immunomodulator (Sepsivac, Mycobacterium Heat Killed Injections) Used in Auranofin, Sepsis and Viosis,
¬ Allogeneic Placental Expanded (Plx) Cells.

Since the emergency care of COVID-19 patients requires the use of effective drugs in addition to the beneficial effects of Remdesivir to control the disease and stop the pandemic, Hydroxychloroquine sulfate and Chloroquine phosphate, which have been used for decades for the treatment and control of malaria and autoimmune diseases, are used to distribute in hospitalized COVID-19 patients. and its use is permitted.

In post-transmission prophylaxis studies, studies on hydroxychloroquine's ability to inhibit the replication of SARS-CoV-2 in vitro have not yet been identified, but it is thought that it may be useful when the infection is initiated as early as possible after diagnosis. There is convincing evidence that hydroxychloroquine has in vitro antiviral activity against SARS-CoV-2.

While fighting the epidemic disease, it has become important to pay attention to the Potential Drug-Drug Interaction due to similar side effects between prescribed metabolism-based drugs and COVID-19 therapeutic agents. COVID-19 affects multiple organ systems, including the gastrointestinal, renal, cardiovascular, pulmonary, immunological and hematological systems. This may lead to pharmacokinetic changes affecting psychotropic drugs and increase susceptibility to side effects associated with psychotropic drugs. Additionally, several treatments recommended for COVID-19 have neuropsychiatric effects and potential interactions with commonly used psychotropes.

Until the results of the study emerge, the National Institutes of Health (NIH) will prevent drug-drug interactions in the management of guidelines on testing and management of COVID-19 patients and attention should be paid to their safe use in combination with COVID-19 pharmacotherapy.

Dr. Lecturer Sema KETENCİ, Member
Atlas University School of Medicine
Medical Pharmacology USA