Reported Mechanisms and Toxicity of Investigational Treatments for SARS-COV-2 Chloroquine and Hydroxychloroquine • Mechanisms: Interference with ligand binding, interference with viral RNA release into cytosol, decreased viral budding, and alteration in immune viral response • Toxicity: Cardiac conduction abnormalities, myocardial depression, hypokalemia, hypoglycemia, ocular toxicity, ototoxicity, neuropsychiatric effects Azithromycin • Mechanisms: Inhibits viral internalization, inhibits viral replication, upregulation of interferon I and 3 response • Toxicity: QTc prolongation, hepatotoxicity, sensorineural hearing loss, GI symptoms Lopinavir/Ritonavir • Mechanism: Inhibition viral protein cleavage decreasing viral replication • Toxicity: Drug-drug interactions, elevated triglycerides, potential increased MI risk with chronic use Remdesivir and Favipiravir • Mechanism: Nucleoside analogues, results in early termination of viral RNA replication • Toxicity (expected): myopathy, hepatitis, neuropathy, lactic acidosis, renal injury (Remdesivir) Ivermectin • Mechanism: Interference with nuclear import of viral • Toxicity: Neurotoxicity (overdose or when combined with certain medications), hypotension (overdose), hepatotoxicity This Week in Tox @thisweekintox #Toxicity #Toxicology #Medications #SARSCOV2 #COVID19 #Coronavirus