Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 23-26 November 2020

EMA's safety committee (PRAC) has recommended updating the product information for all chloroquine or hydroxychloroquine-containing medicines following a review of all available data that confirmed a link between the use of these medicines and the risk of psychiatric disorders and suicidal behaviour.

The review was initiated in May 2020 after EMA had been informed by the Spanish Medicines Agency AEMPS of six cases of psychiatric disorders in patients with COVID-19 who were given higher than authorised doses of hydroxychloroquine. Chloroquine and hydroxychloroquine are authorised in the EU for the treatment of certain autoimmune diseases, such as rheumatoid arthritis and lupus, as well as for prophylaxis and treatment of malaria. They are not authorised for the treatment of COVID-19, but both medicines have been used as off-label treatment in patients with the disease. However, chloroquine and hydroxychloroquine have not shown any beneficial effects in treating COVID-19 in large randomised clinical trials.

In view of their use during the COVID-19 pandemic, EMA had reminded healthcare professionals of the risks of these medicines in April and in May 2020. It is already known that chloroquine and hydroxychloroquine, even used in approved doses for authorised indications, can cause a wide spectrum of psychiatric disorders. Psychotic disorders and suicidal behaviour are listed in the product information of some chloroquine or hydroxychloroquine-containing medicines as rare side effects or side effects occurring at an unknown frequency.

The review confirmed that psychiatric disorders have occurred and may sometimes be serious, both in patients with and without prior mental health problems. Based on the available data, the review showed that, for hydroxychloroquine, the side effects may occur in the first month after the start of treatment. For chloroquine, there was not sufficient data to establish a clear timeframe.

The PRAC recommends updating the product information for these medicines to provide better information to healthcare professionals and patients on the risk of suicidal behaviour and psychiatric disorders.

Patients using chloroquine or hydroxychloroquine medicines who experience mental health problems (e.g. irrational thoughts, anxiety, hallucinations, feeling confused or feeling depressed, including thoughts of self-harm or suicide), or others around them who notice these side effects, should contact  a doctor straight away.

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