Role of clinical pharmacist in the optimisation of nirmatrelvir/ritonavir prescription in the emergency department

Background and ImportanceNirmatrelvir/ritonavir (Paxlovid®) has been recently authorised for treating coronavirus disease 2019 (COVID-19) in adults who do not require supplemental oxygen and who are at increased risk for progressing to severe disease. Due to multiple drugs metabolised by CYP3A may have significant interactions with ritonavir, physicians and pharmacists should work together for the safe and effective use of paxlovid.Aim and ObjectivesTo describe the pharmacist interventions (PIs) in the emergency department (ED) regarding optimisation of paxlovid prescriptions in non-hospitalised COVID-19 patients.Material and MethodsAn observational prospective study was conducted from 1 April 2022 to 31 August 2022 in a 1000-bed university hospital. Clinical variables were obtained using electronic medical records. We registered demographic data (sex, age), vaccination status and comorbidities, hospitalisation and prescription with other therapies (such as remdesivir and baricitinib) after paxlovid treatment, posology, potential drug interactions and contraindications. PIs were classified into the following types: (1) dose adjustment, (2) contraindication, (3) potential interaction, (4) non-compliance with the indication. We also identified primary non-adherence to paxlovid.ResultsWe included 77 patients, 56% female, median age of 67 years (IQR 52-81). Most patients (87%) were fully vaccinated (including booster dose), 12% required subsequent hospitalisation for COVID-19, none of them died and only one patient required remdesivir as other therapies. In relation to comorbidities, 86% of patients had respiratory diseases, 33% hypertension, 30% cancer treated with chemotherapy, 21% autoimmune diseases, 17% renal disease, 16% diabetes mellitus, 9% liver disease. The percentage of patients with PIs was 70%. The total of PIs carried out was 87:(1) 31%, (2) 13%, (3) 33%, (4) 23%. Forty-six potential interactions were detected being the most frequent: statins (33%), antihypertensives (11%), anticoagulants (6%), immunosuppressants (6%), among other drugs, as well as, 14 contraindications, in which statins again stood out. Primary non-adherence was detected in 10% of patients. 100% of PI were accepted.Conclusion and RelevanceHospital pharmacists are key in the optimisation of paxlovid prescriptions in the ED. This includes assessing for potential drug interactions, as well as contraindications, among other PIs. Due to the recent conditional marketing authorisation of paxlovid, it is important to encourage multidisciplinary work to reduce potential dosing errors and adverse reactions, increasing patient safety.References and/or AcknowledgementsConflict of InterestNo conflict of interest

Experience of using remdesivir in the treatment of patients with sars-CoV2 infection

Background and ImportanceRemdesivir was the first antiviral authorised by the European Medicines Agency for the treatment of CoVID-19 disease.Aim and ObjectivesThe aim is to describe the effectiveness and safety of remdesivir in patients with SARS-CoV-2 infection in real clinical practice.Material and MethodsObservational, descriptive, retrospective study in a level-II hospital.Hospitalised patients with SARS-CoV-2 infection and prescription of remdesivir from April21-March22 were included. Data were obtained from the Unidosis Farmatools® module and MambrinoXXI®.Variables: sex, age, recommendations of remdesivir datasheet (time from symptom onset to administration ≤7-days, dosing regimen, duration of treatment and glomerular filtration rate (GFR) (contraindicated if <30mL/min).Effectiveness assessment: hospital stay, Intensive Care Unit (ICU) admission, clinical recovery inpatients with 5-day treatment.Safety assessment: elevated transaminases (pre-and-post-remdesivir levels;contraindicated if ≥5 times upper limit of normal-LSN)Results59 patients were included, 64% male, median age 67(30-101) years.100% started within 7-days of symptomatology onset (median: 3-days) and complied with the recommended dosing regimen. In 93.2% the duration was 5-days, one patient remained on treatment for 7-days and 3 discontinued earlier due to clinical worsening. Mean GFR: 79ml/min and96.6% complied with the recommendation (GFR>30ml/min).The median hospital stay was 8-days (3-133). Twelve patients required admission to the ICU, two of whom died. Clinical recovery was achieved in 91.1% of patients who completed the 5-day regimen. During the hospital stay, 7 patients died with a median age of 85 years (59-95).Prior to administration, 22.2% patients showed transaminase levels above the LSN, including one patient with 5LSN. After administration, transaminases increased in 31.1%, including 5 patients with 5LSN, 2 of whom had initially normal values.Conclusion and RelevanceAll patients received remdesivir as early as recommended and according to the conclusions of the pivotal clinical trial, where this subgroup was postulated to have the greatest clinical benefit. Although one third of patients had elevated transaminasemia, none required treatment discontinuation. However, other parameters would need to be collected to assess safety more comprehensively. Despite the limitations of the study, in our experience, remdesivir appears to have a good effectiveness and safety profile and may be a therapeutic alternative in the treatment of COVID-19disease.References and/or AcknowledgementsConflict of InterestNo conflict of interest

Systemic sclerosis following COVID-19 infection with recurrent corticosteroid-induced scleroderma renal crisis.

Systemic sclerosis is a complex multisystem connective tissue disease resulting in fibrosis of the skin and internal organs. Exposure to corticosteroids can trigger scleroderma renal crisis, a life-threatening complication of the disease. Autoimmune disease following infection with COVID-19 is being increasingly recognised. The mechanisms of post-COVID-19 autoimmunity are likely multifactorial, involving immune dysregulation, molecular mimicry and the development of cross-reactive antibodies. There are currently only two reported cases of systemic sclerosis occurring post-COVID-19 infection.We present the case of a female patient who developed systemic sclerosis post-COVID-19 infection. Following exposure to corticosteroids, the patient developed scleroderma renal crisis complicated by thrombotic microangiopathy, seizures and acute renal failure. Despite an antibody profile not typically associated with renal crisis (anti-topoisomerase positive, anti-RNA-polymerase III negative), the patient developed recurrent renal crisis with repeated exposure to corticosteroid therapy, highlighting the risk of steroid use in all patients with systemic sclerosis.

From Immunogen to COVID-19 vaccines: Prospects for the post-pandemic era.

The COVID-19 pandemic has affected millions of people and posed an unprecedented burden on healthcare systems and economies worldwide since the outbreak of the COVID-19. A considerable number of nations have investigated COVID-19 and proposed a series of prevention and treatment strategies thus far. The pandemic prevention strategies implemented in China have suggested that the spread of COVID-19 can be effectively reduced by restricting large-scale gathering, developing community-scale nucleic acid testing, and conducting epidemiological investigations, whereas sporadic cases have always been identified in numerous places. Currently, there is still no decisive therapy for COVID-19 or related complications. The development of COVID-19 vaccines has raised the hope for mitigating this pandemic based on the intercross immunity induced by COVID-19. Thus far, several types of COVID-19 vaccines have been developed and released to into financial markets. From the perspective of vaccine use in globe, COVID-19 vaccines are beneficial to mitigate the pandemic, whereas the relative adverse events have been reported progressively. This is a review about the development, challenges and prospects of COVID-19 vaccines, and it can provide more insights into all aspects of the vaccines.

Traditional Chinese Medicine in Distance Physiotherapy of non-specific Back Pain during the COVID-19 Pandemic

This paper deals with the use of meridian exercises of Traditional Chinese medicine in physiotherapy. On a selected sample of 30 probands aged between 19 to 55 years who met the set criteria, the effect of exercises for non-specific pain in the cervical, thoracic and lumbar spine was examined. The pilot prospective study compares the intensity of pain in 3 areas of the back before the start of a 4-week cycle exercise at least 3 times a week and after the end of the exercise cycle. After a series of meridian exercises there was a statistically significant pain reduction in the cervical spine (p < 0.05), in the thoracic spine (p < 0.05) and on the level (p < 0.05) in the lumbar spine. The pain frequency during the week decreased by an average (p< 0.05) of a day. The pilot study unequivocally confirmed the positive effect of meridian exercises on reducing the intensity of pain in 3 back areas as well as on reducing the frequency of perceived pain. The addressed issue has a perspective both on the level of physiotherapeutic procedures and their diagnostic use and from the point of view of Traditional Chinese Medicine with the impact of meridian exercises on individual elements, such as organ systems.

Potential Cyp3a4-Mediated Drug-Drug Interactions with Ritonavir-Containing Medications in U.S. Patients with Diabetes or Cardiovascular Diseases: An Analysis of Nhanes Data

This cross-sectional study examined the 2015-2019 National Health and Nutrition Examination Surveys (NHANES), which has been used in previous COVID-19 research, to estimate the proportion of adults with diabetes and serious heart conditions (SHCs) at risk of potential drug-drug interactions (pDDIs) arising from concomitant use of ritonavir and medications used to treat their comorbid conditions. Medications metabolized through the CYP3A4 pathway were identified as having pDDI with ritonavir, and were categorized as contraindicated, major, moderate, or minor pDDI severity using data sources from University of Liverpool, Lexicomp® and the FDA. Age-stratified prevalence of pDDIs were estimated using U.S. population weights (Table 1). 6.3% and 11.0% of survey participants reported a diagnosis of SHC and diabetes, respectively. pDDIs of any severity were identified in 44.5% of all adults;with 28.4% at risk of major or contraindicated pDDIs. Major or contraindicated pDDIs were observed in 58.1% of adults 60+. Among individuals with diabetes and SHCs, respectively, pDDIs were identified in 83.5% and 90.9% of all adults and in 92.1% and 95.5% of adults 60+. Major or contraindicated pDDIs were identified in 69.5% and 80.2% of adults with diabetes and SHC, respectively;and in 81.4% and 86.0% of individuals with diabetes and SHC aged 60+. This study suggests that majority of U.S. adults with diabetes or SHC are at risk of a major or contraindicated pDDI if treated with ritonavir-containing therapies. Findings highlight the importance of pDDI assessments in determining appropriate COVID-19 therapies, especially for multimorbid and elderly patients.

Prevalence of Medical Contraindications to Nirmatrelvir/Ritonavir in a Cohort of Hospitalized and Nonhospitalized Patients With COVID-19.

This analysis describes the prevalence of contraindications to nirmatrelvir/ritonavir among 66 007 patients with coronavirus disease 2019 in a large health care system. A possible contradiction was present in 9830 patients (14.8%), with the prevalence of contraindications increasing with higher acuity of illness.

Questions on Immunization and Vaccination and Short Answers: Journal of Pediatric Infection

The antibody response to the vaccine is considered protective after day 14. [...]it should be remembered that protection against influenza begins as of the 14th day of vaccination. Following their meeting on November 3rd, 2021, the COVID-19 Scientific Advisory Board recommended three primary doses for people who "received a solid organ transplant or bone marrow transplant, have active cancer, HIV infection with a CD4 count below 200, are on hemodialysis, or are severely immunosuppressed with high-dose steroids or biological agents." Antibody response after a third dose of the mRNA-1273 SARS-CoV-2 vaccine in kidney transplant recipients with minimal serologic response to 2 doses.

Progress and early outcomes of a cardiometabolic clinic in a uk tertiary cardiology centre

128 Table 1Referral origin of patients seen 128 Table 2Patient characteristics 128 male 54 female 128 Table 3Onward referrals 128 Table 4Medications initiated, titrated, stoppedConclusionThe CMC is a novel integrative approach to optimising management of cardiometabolic risk and incorporation of evidence-based cardiometabolic medications. As risk of morbidity and mortality due non-communicable diseases intensifies in an increasingly comorbid population and in the context of a resource-strained health service, efficient care models such as the CMC are an important enterprise to address cardiometabolic risk and disease. As this clinic expands its service, it will continue to serve as example for comparable innovation in other centres.Conflict of InterestNone

Is our protocol for the use of tocilizumab in COVID patients adequate?

Background and importanceTocilizumab (TCZ) has been a key pillar in the management of pulmonary hyperinflammation in patients with SARS-CoV-2 pneumonia. The incessant publication of new studies assessing its effectiveness and the ideal time of use means that in-hospital protocols are constantly being reviewed and updated.Aim and objectivesTo describe the clinical characteristics of hospitalised patients with SARS-CoV-2 pneumonia treated with TCZ and their evolution, and to compare our results with those of the primary endpoint (28-day mortality) of the RECOVERY study.Material and methodsRetrospective observational study of patients administered TCZ between October 2020 and February 2021 in a tertiary hospital. Criteria for TCZ use were PAFI <300 and meeting two of the following three criteria: C-reactive protein (CRP) >150 mg/L, D-dimer >1500 ng/mL and ferritin >2000 ng/mL, and not having contraindications for its use.Each patient received a single dose of 400 mg if weight <75 kg and 600 mg if weight >75 kg.Demographic data, comorbidities and days from symptom onset to TCZ administration were collected. Follow-up of analytical data (CRP, D-dimer and ferritin pre- and post- (15 days) TCZ administration). Clinical evolution was evaluated by mortality rate at 28 days.Statistical analysis: Stata/MP v16.0. Student’s t-test was used for comparison of quantitative variables.Results39 patients were included, 25 (64.1%) were male, median age 74 (IQR 61–80) years. 61.5% had hypertension, 33.3% obesity, 41% diabetes mellitus, 17.9% chronic kidney disease, 12.8% heart disease. The median time from symptom onset to TCZ administration was 10 (IQR 7–15) days.The medians prior to and at 15 days of TCZ administration were, respectively: 152.5 mg/L (IQR 89–220.8) and 1.7 mg/L (IQR 0.65–4.2) CRP (p<0.001);2300 ng/mL (IQR 11 959–4889) and 1124 ng/mL (IQR 567–1439) D-dimer (p=0.1726);1242 ng/mL (IQR 647–2705) and 851 ng/mL (IQR 268–1384) ferritin (p=0.1294). Mortality at 28 days was 64.1%.Conclusion and relevanceOur sample size is smaller than that of the RECOVERY study;however, the days of symptoms until TCZ administration (10 vs 9) and the median CRP prior to TCZ (143 vs 152.5 mg/L) in both studies are very similar. Our mortality is much higher (64.1% vs 29%). We found a statistically significant difference between our pre- and post-CRP data.With this result, the in-hospital protocol was modified and new criteria for TCZ administration in COVID patients became oxygen saturation <92% or PAFI >300 and CRP >75 mg/L, with no contraindications for use.In subsequent studies we will test whether this update helps to improve mortality outcomes.References and/or acknowledgementsConflict of interestNo conflict of interest

Missed Opportunities for Vaccination and Associated Factors among Children Attending Primary Health Care Facilities in Cape Town, South Africa: A Pre-Intervention Multilevel Analysis

Despite the substantial efforts at ensuring universal access to routine immunisation services among children in South Africa, major gaps in immunisation coverage remain. This study assessed the magnitude of missed opportunities for vaccination (MOV) and associated factors among children aged 0–23 months attending primary health care (PHC) facilities in Cape Town. We used multilevel binomial logistic regression models to explore individual and contextual factors associated with MOV, with children aged 0–23 months at Level 1, nested within PHC facilities (Level 2). A total of 674 children and their caregivers were enrolled. MOV prevalence was 14.1%, ranging from 9.1% to 18.9% across sub-districts. Dose-specific MOV prevalence was highest for the second dose of measles vaccine (9.5%) and lowest for the first dose of rotavirus vaccine (0.6%). The likelihood of a child experiencing MOV was significantly associated with caregivers’ low level of education (Odds ratio (OR) = 3.53, 95% credible interval (CrI): 1.13–11.03), recent receipt of immunisation messages (OR = 0.46, 95%CrI: 0.25–0.87), shared immunisation decision making by both parents (OR = 0.21, 95%CrI: 0.07–0.62) and health facility staff number (OR = 0.18, 95%CrI: 0.06–0.61). The burden of MOV among children in Cape Town is influenced by individual and contextual factors, which provide important opportunities for quality improvement and broader strategies to improve routine immunisation service delivery.

Feasibility of randomizing Danish citizens aged 65–79 years to high-dose quadrivalent influenza vaccine vs. standard-dose quadrivalent influenza vaccine in a pragmatic registry-based setting: rationale and design of the DANFLU-1 Trial

Background High-dose influenza vaccines provide better protection against influenza infection than standard-dose in persons aged 65 years and above;however, in most countries, high-dose vaccines are not widely implemented. Assessing the relative effectiveness of high-dose compared to standard-dose vaccines on hospitalizations and mortality would enable more robust public health and cost-effectiveness estimates. This study aims to investigate the feasibility of conducting a pragmatic randomized clinical trial in Denmark comparing high-dose to standard-dose vaccines utilizing existing vaccination infrastructure and the Danish nationwide health registries for data collection. Methods The DANFLU-1 trial (NCT05048589) is a pragmatic, open-label, active-controlled randomized trial randomizing Danish citizens aged 65–79 years to either high-dose quadrivalent influenza vaccine or standard-dose quadrivalent influenza vaccine. The study utilizes the infrastructure of a private vaccination provider (Danske Lægers Vaccinations Service) for recruitment, inclusion, randomization, and vaccination. All collection of baseline and follow-up data including safety monitoring is performed centrally by the Department of Cardiology at Herlev and Gentofte Hospital, Copenhagen, Denmark using the Danish nationwide health registries. The study aims to include 40,000 participants during the 2021/2022 influenza season. The primary endpoints address feasibility and include the number of participants enrolled, randomization balance, and representativeness compared to the Danish general population. Relative vaccine effectiveness will also be assessed, however, this feasibility study is not powered for clinical outcomes and may be affected by the COVID-19 pandemic. Discussion The DANFLU-1 study is investigating the feasibility of conducting a large-scale pragmatic clinical trial in Denmark utilizing existing infrastructure and the Danish nationwide registries. This will provide valuable insight, especially for potential future fully powered vaccine trials, but also for trials wishing to investigate other interventions. Trial registration Clinicaltrials.gov: NCT05048589, registered September 17, 2021.

Endocrine Management of Transgender Adults: A Clinical Approach

The attention to transgender medicine has changed over the last decade and the interest is most likely going to increase in the future due to the fact that gender-affirming treatments are now being requested by an increasing number of transgender people. Even if gender-affirming hormone therapy (GAHT) is based on a multidisciplinary approach, this review is going to focus on the procedures adopted by the endocrinologist in an out-clinic setting once an adult patient is referred by another specialist for ‘gender affirming’ therapy. Before commencing this latter treatment, several background information on unmet needs regarding medical and surgical outcomes should be investigated. We summarized our endocrinological clinical and therapeutic approaches to adult transgender individuals before and during GAHT based on a non-systematic review. Moreover, the possible relationships between GAHT, gender-related pharmacology, and COVID-19 are also reported.

HISTO-ANATOMICAL STUDIES IN TUSSILAGO FARFARA L. A SPECIES WITH MEDICINAL POTENTIAL AGAINST RESPIRATORY DISEASES

This study aimed to describe the histo-anatomy of Tussilago farfara L. species from the Asteraceae family, with medicinal importance in Romania for the alternative treatment of respiratory diseases (asthma, laryngitis, cough, emphysema) and other disorders. The chemical composition of Coltsfoot includes more than 150 chemical substances (triterpenoids, sesquiterpenoids, alkaloids) with different medicinal proprieties (expectorant, antimicrobial, antitussive) and contraindications (pregnancy, lactation, hepatic disorders). The vegetal material used in this study was collected from the waterside of river Sireţel in the village Sireţel from Sireţel commune in Iaşi County. The cross-sections were performed manually through vegetative organs (rhizome, stem, and leaf) with the help of a hand microtome and a botanic razor. The structures of the sections were highlighted by double coloration (iodine green and ruthenium red), the observation was performed on a Novex microscope. The characteristics structures observed by us (epidermis, vascular bundles, trichomes, angular collenchyma, assimilating parenchyma, stomata, mesophyll) correspond with Toma and Rugină (1998) observations and descriptions.

Digital ischaemia and necrosis from oxaliplatin.

Oxaliplatin is a chemotherapeutic agent used in a variety of malignancies such as colorectal cancer and pancreatic cancer. It is a platinum derivative that results in direct cell cytotoxicity with resultant cell death. The most common side effects often noted are neurotoxicity, nausea, vomiting, diarrhoea, hepatotoxicity and myelosuppression. Oxaliplatin induced digital ischaemia and necrosis is a rare side effect that was observed in our patient. In general, digital ischaemia is a rare vascular disorder that is often associated with autoimmune disease. A patient with digital ischaemia due to oxaliplatin will be described in this case report.

Alternatives to Opioids for Acute Pain Management in the Emergency Department

* Since the opioid crisis is still present, if not worse, it is important for emergency physicians to avoid the use of opioids whenever possible. * Many alternatives exist. Nitrous oxide provides short-term analgesia and can be used in children as young as 1 year of age. * Sub-dissociative doses of ketamine can be used for acute pain relief. Slow infusion decreases the psychoperceptual effects commonly seen with ketamine. It may be of some use even in chronic pain. * Intravenous lidocaine had been recommended for acute pain, particularly due to renal colic. However, more recent studies suggest it is inferior to ketorolac. * The use of ultrasound-guided regional anesthesia has been increasing and has been shown to be of value in acute trauma, central line placement, renal colic, zoster, and chest tube placement.

Nirmatrelvir and Ritonavir Tablets (Paxlovid)

INDICATIONS NIR/RIT can be prescribed to treat mild-to-moderate COVID-19 in patients age 12 years and older weighing at least 40 kg with positive results of direct SARS-CoV-2 testing who are at high risk for progression to severe COVID-19, including hospitalization or death.1 NIR/RIT is not indicated for pre-exposure or post-exposure prevention of COVID-19. < 1%).1 COMMENTS NIR inhibition of the Mpro prevents replication of SARS-CoV-2.1 Data supporting the EUA for NIR/RIT was a Phase II/III randomized, double-blind, placebo-controlled study.1 Subjects were nonhospitalized, symptomatic adults with laboratory-confirmed diagnosis of SARS-CoV-2 infection at risk for progression to severe disease. Risk factors included diabetes, BMI > 25 kg/m2, chronic lung disease, chronic kidney disease, current smoker, immunosuppressive disease/immunosuppressive treatment, cardiovascular disease, hypertension, sickle cell disease, neurodevelopmental disorders, active cancer, or ≥ age 60 years regardless of comorbidities.

Triple infection with disseminated tuberculosis, invasive aspergillosis and COVID-19 in an organ transplant recipient with iatrogenic immunosuppression.

A 39-year-old man with diabetes mellitus and hypertension presented two years following renal transplantation with evening pyrexia, night sweats and loss of weight. He was diagnosed with disseminated tuberculosis and invasive aspergillosis and commenced on antituberculous and antifungal therapy. Immunosuppressants except for the maintenance dose of steroids were discontinued. Two weeks later, he acquired severe COVID-19 pneumonia complicated with type 1 respiratory failure and haemodynamic instability. He was treated with non-invasive ventilation and inotropic support with a vasopressor-augmenting dose of steroids. Management challenges were diagnosing the respiratory pathologies with limited investigations, deciding on continuation of steroids in an organ transplant recipient with disseminated infection and deciding the ceiling of care in a low-resource setting given the background of multiple pulmonary insults. A multidisciplinary team decided to continue high-dose steroids and escalate to a full ceiling of care. He recovered from COVID-19 pneumonia 15 days following diagnosis and was discharged home. The potential adverse effects of steroids on tuberculosis and aspergillosis are to be monitored during follow-up.

Tylenol or acetaminophen: a recurrent fixed drug eruption perpetuated through the use of inconsistent drug terminology.

An 87-year-old man with a history of osteoarthritis presented with worsening knee pain. He was prescribed acetaminophen with codeine. A few days later, he developed a rash on his right buttock and proximal thigh, similar to a rash he experienced in the past when he took over-the-counter (OTC) acetamenophen and an unknown lozenge to treat a presumed viral illness. A fixed drug eruption (FDE) was diagnosed and the patient was asked to avoid Tylenol and other OTC lozenges. Tylenol was entered as an allergy in the electronic medical records. However, since Tylenol, not acetaminophen was listed in the allergy profile, the order for acetaminophen and codeine did not generate an alert for the prescribing physician. Additionally, the dispensing pharmacist did not question the prescribing physician and the patient, unaware that acetaminophen in the pain medication is the same drug as Tylenol, took it and developed recurrent FDE.

A call to caution when hydroxychloroquine is given to elderly patients with COVID-19.

INTRODUCTION: Use of hydroxychloroquine in patients with coronavirus disease 2019 (COVID-19) was widespread and uncontrolled until recently. Patients vulnerable to severe COVID-19 are at risk of hydroxychloroquine interactions with co-morbidities and co-medications contributing to detrimental, including fatal, adverse treatment effects. METHODS: A retrospective survey was undertaken of health conditions and co-medications of patients with COVID-19 who were pre-screened for enrolment in a randomized, double-blind, placebo-controlled hydroxychloroquine multi-centre trial. RESULTS: The survey involved 305 patients [median age 71 (interquartile range 59-81) years]. The majority of patients (n = 279, 92%) considered for inclusion in the clinical trial were not eligible, mainly due to safety concerns caused by health conditions or co-medications. The most common were QT-prolonging drugs (n = 188, 62%) and haematologic/haemato-oncologic diseases (n = 39, 13%) which prohibited the administration of hydroxychloroquine. In addition, 165 (54%) patients had health conditions and 167 (55%) patients were on co-medications that did not prohibit the use of hydroxychloroquine but had a risk of adverse interactions with hydroxychloroquine. The most common were diabetes (n = 86, 28%), renal insufficiency (n = 69, 23%) and heart failure (n = 58, 19%). CONCLUSION: The majority of hospitalized patients with COVID-19 had health conditions or took co-medications precluding safe treatment with hydroxychloroquine. Therefore, hydroxychloroquine should be administered with extreme caution in elderly patients with COVID-19, and only in clinical trials.