A Systematic Review of the Auditory and Vestibular Effects of Chloroquine and Hydroxychloroquine

Abstract

Introduction: chloroquine and hydroxychloroquine are antimalarial drugs that, although normally well tolerated, have side effects, such as gastrointestinal intolerance, retinopathy and arrhythmias. There are reports of sensorineural hearing loss, tinnitus and vertigo related to the two drugs. However, the ototoxic potential of these medications is routinely not researched. With the significant increase in the use of these drugs in the face of the COVID-19 pandemic, the study of their ototoxic effects becomes even more important. Objective: to evaluate the ototoxic potential of chloroquine and hydroxychloroquine through a systematic review of the articles available in the literature. Method: a search for articles published until April 2020 was carried out in the PubMed, Web of Science, SciELO and Lilacs databases, with descriptors registered in MeSH. Articles that associated the use of chloroquine or hydroxychloroquine with auditory and / or vestibular effects were included. Result: the search resulted in 161 articles, of which 18 met the inclusion criteria. Of these, 16 demonstrated ototoxic effects of chloroquine and / or hydroxychloroquine. Chloroquine was considered the second main drug involved in ototoxicity in 2 studies. A 5-fold higher risk of hearing loss has also been reported in neonates whose mothers used chloroquine during pregnancy. Conclusion: studies have shown that chloroquine and hydroxychloroquine have ototoxic action, which may initially go unnoticed if there is no active investigation. The significant increase in the use of chloroquine and hydroxychloroquine in the face of the COVID-19 pandemic may represent an escalation in ototoxicity, which should not be neglected.