{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:14:09Z","timestamp":1791976449202,"version":"4.4.0"},"reference-count":113,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","funder":[{"DOI":"10.13039\/sp9gjvtkjkmi","name":"Verdun Research Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/sp9gjvtkjkmi","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JASN"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>Although poisoning by chloroquine, hydroxychloroquine, or quinine is relatively uncommon, recent use of chloroquine and hydroxychloroquine for COVID-19 has elevated concerns regarding management of such poisonings. To investigate the effect of and indications for extracorporeal treatments in cases of poisoning with these drugs, the Extracorporeal Treatments in Poisoning workgroup conducted systematic reviews of the relevant literature, screened studies, extracted data, and summarized findings. The group concluded that chloroquine, hydroxychloroquine, and quinine are not dialyzable (not amenable to clinically significant removal by extracorporeal treatments) and the current clinical evidence does not support the use of such treatments for chloroquine and quinine poisonings. Considering that data on extracorporeal treatments for hydroxychloroquine toxicity are sparse, the group proposed pharmacokinetic studies to confirm or refute the current impression that the drug is non-dialyzable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although chloroquine, hydroxychloroquine, and quinine are used for a range of medical conditions, recent research suggested a potential role in treating COVID-19. The resultant increase in prescribing was accompanied by an increase in adverse events, including severe toxicity and death. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup sought to determine the effect of and indications for extracorporeal treatments in cases of poisoning with these drugs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted systematic reviews of the literature, screened studies, extracted data, and summarized findings following published EXTRIP methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 44 studies (three\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      studies, two animal studies, 28 patient reports or patient series, and 11 pharmacokinetic studies) met inclusion criteria regarding the effect of extracorporeal treatments. Toxicokinetic or pharmacokinetic analysis was available for 61 patients (13 chloroquine, three hydroxychloroquine, and 45 quinine). Clinical data were available for analysis from 38 patients, including 12 with chloroquine toxicity, one with hydroxychloroquine toxicity, and 25 with quinine toxicity. All three drugs were classified as non-dialyzable (not amenable to clinically significant removal by extracorporeal treatments). The available data do not support using extracorporeal treatments in addition to standard care for patients severely poisoned with either chloroquine or quinine (strong recommendation, very low quality of evidence). Although hydroxychloroquine was assessed as being non-dialyzable, the clinical evidence was not sufficient to support a formal recommendation regarding the use of extracorporeal treatments for this drug.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>On the basis of our systematic review and analysis, the EXTRIP workgroup recommends against using extracorporeal methods to enhance elimination of these drugs in patients with severe chloroquine or quinine poisoning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1681\/asn.2020050564","type":"journal-article","created":{"date-parts":[[2020,9,22]],"date-time":"2020-09-22T17:03:38Z","timestamp":1600794218000},"page":"2475-2489","source":"Crossref","is-referenced-by-count":24,"title":["Extracorporeal Treatment for Chloroquine, Hydroxychloroquine, and Quinine Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup"],"prefix":"10.1681","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8993-2693","authenticated-orcid":false,"given":"Ingrid","family":"Berling","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Calvary Mater Newcastle, Waratah, New South Wales, Australia"},{"name":"Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Waratah, New South Wales, Australia"},{"name":"School of Medicine and Public Health, University of Newcastle Newcastle, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua D.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine and School of Pharmacy, University of Maryland, Baltimore, Maryland"},{"name":"Maryland Poison Center, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greene","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0091-9573","authenticated-orcid":false,"given":"Robert S.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York City, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5316-5990","authenticated-orcid":false,"given":"Badria","family":"Alhatali","sequence":"additional","affiliation":[{"name":"Poison Control Section, Department of Environmental and Occupational Health, Ministry of Health, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valery","family":"Lavergne","sequence":"additional","affiliation":[{"name":"Research Center, Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et de Services Sociaux du Nord-de-l'\u00eele-de-Montr\u00e9al, H\u00f4pital du Sacr\u00e9-Coeur de Montr\u00e9al, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9101-7577","authenticated-orcid":false,"given":"Darren M.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine and Transplantation, St. Vincent\u2019s Hospital, Sydney, New South Wales, Australia"},{"name":"Department of Clinical Pharmacology and Toxicology, St. Vincent\u2019s Hospital, Sydney, New South Wales, Australia"},{"name":"St. Vincent\u2019s Clinical School, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Gosselin","sequence":"additional","affiliation":[{"name":"Centre Int\u00e9gr\u00e9 de Sant\u00e9 et de Services Sociaux Mont\u00e9r\u00e9gie-Centre Emergency Department, H\u00f4pital Charles-Lemoyne, Greenfield Park, Quebec, Canada"},{"name":"Department of Emergency Medicine, McGill University, Montreal, Quebec, Canada"},{"name":"Centre Antipoison du Qu\u00e9bec, Quebec City, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Wilson","sequence":"additional","affiliation":[{"name":"Research Center, Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et de Services Sociaux du Nord-de-l'\u00eele-de-Montr\u00e9al, H\u00f4pital du Sacr\u00e9-Coeur de Montr\u00e9al, University of Montreal, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4339-1382","authenticated-orcid":false,"given":"Thomas D.","family":"Nolin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania"},{"name":"Department of Medicine Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Ghannoum","sequence":"additional","affiliation":[{"name":"Research Center, Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et de Services Sociaux du Nord-de-l'\u00eele-de-Montr\u00e9al, H\u00f4pital du Sacr\u00e9-Coeur de Montr\u00e9al, University of Montreal, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the EXTRIP workgroup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,9,22]]},"reference":[{"key":"B1-20230829","doi-asserted-by":"crossref","first-page":"105949","DOI":"10.1016\/j.ijantimicag.2020.105949","article-title":"Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial","volume":"56","author":"Gautret","year":"2020","journal-title":"Int J Antimicrob Agents"},{"key":"B2-20230829","doi-asserted-by":"crossref","first-page":"105932","DOI":"10.1016\/j.ijantimicag.2020.105932","article-title":"Chloroquine and hydroxychloroquine as available 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