Lenkens M, de Wit H, Danser A H, Esselink A C, Horikx A, Ten Oever J, van de Veerdonk F, Kramers C
CWZ, afd. Interne Geneeskunde, Nijmegen.
CWZ, afd. Klinische Farmacie, Nijmegen.
Ned Tijdschr Geneeskd. 2020 Mar 25;164:D4995.
This paper discusses the possible effects of comedication on COVID-19 and the current treatment options for this infection. It is very doubtful that comedication has a disadvantageous effect on the course of the disease. NSAIDs should be avoided in any patient with a possible severe disease, because of potential side effects. Inhibitors of the renin-angiotensin aldosterone system should be continued when there is a solid indication, and stopped in case of hemodynamic problems. There is no preference for either ACE inhibitors or angiotensin II receptor inhibitors. Currently, chloroquine and remdesivir are possible treatment options. There is no sound evidence for either treatment. Chloroquine has side effects (nausea, QT prolongation) and there are several drug interactions. The treatment should be reconsidered in the event of side effects and when inferior medication for comorbidity must be prescribed because of possible interactions. Lopinavir/ritonavir is not effective. Supportive care is at present the mainstay of the treatment.
本文讨论了联合用药对新型冠状病毒肺炎（COVID-19）的可能影响以及针对该感染的当前治疗选择。联合用药对疾病进程产生不利影响的可能性非常小。由于存在潜在副作用，任何可能患有严重疾病的患者都应避免使用非甾体抗炎药。当有确凿指征时，肾素-血管紧张素-醛固酮系统抑制剂应继续使用，而在出现血流动力学问题时应停用。对于血管紧张素转换酶抑制剂或血管紧张素II受体抑制剂没有偏好。目前，氯喹和瑞德西韦是可能的治疗选择。尚无这两种治疗方法的可靠证据。氯喹有副作用（恶心、QT间期延长）且存在多种药物相互作用。出现副作用以及因可能的相互作用而必须为合并症开具疗效较差的药物时，应重新考虑治疗方案。洛匹那韦/利托那韦无效。目前，支持性治疗是主要的治疗手段。
