Hydroxychloroquine: a comprehensive review and its controversial role in coronavirus disease 2019

Pankaj Bansal, Amandeep Goyal, Austin Cusick, Shubham Lahan, Harpal S. Dhaliwal, Poonam Bhyan, Pradnya Brijmohan Bhattad, Fawad Aslam, Sagar Ranka, Tarun Dalia, Lovely Chhabra, Devang Sanghavi, Bhavin Sonani, John M. Davis

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


Hydroxychloroquine, initially used as an antimalarial, is used as an immunomodulatory and anti-inflammatory agent for the management of autoimmune and rheumatic diseases such as systemic lupus erythematosus. Lately, there has been interest in its potential efficacy against severe acute respiratory syndrome coronavirus 2, with several speculated mechanisms. The purpose of this review is to elaborate on the mechanisms surrounding hydroxychloroquine. The review is an in-depth analysis of the antimalarial, immunomodulatory, and antiviral mechanisms of hydroxychloroquine, with detailed and novel pictorial explanations. The mechanisms of hydroxychloroquine are related to potential cardiotoxic manifestations and demonstrate potential adverse effects when used for coronavirus disease 2019 (COVID-19). Finally, current literature associated with hydroxychloroquine and COVID-19 has been analyzed to interrelate the mechanisms, adverse effects, and use of hydroxychloroquine in the current pandemic. Currently, there is insufficient evidence about the efficacy and safety of hydroxychloroquine in COVID-19.KEY MESSAGES HCQ, initially an antimalarial agent, is used as an immunomodulatory agent for managing several autoimmune diseases, for which its efficacy is linked to inhibiting lysosomal antigen processing, MHC-II antigen presentation, and TLR functions. HCQ is generally well-tolerated although severe life-threatening adverse effects including cardiomyopathy and conduction defects have been reported. HCQ use in COVID-19 should be discouraged outside clinical trials under strict medical supervision.

Original languageEnglish (US)
Pages (from-to)117-134
Number of pages18
JournalAnnals of Medicine
Issue number1
StatePublished - Jan 1 2021


  • COVID-19
  • Hydroxychloroquine
  • cardiotoxicity
  • mechanism of action

ASJC Scopus subject areas

  • General Medicine


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