Effectiveness of supplemental therapy with ammonium chloride in patients with COVID-19

Introduction of Ammonium chloride

Ammonium chloride is a small molecule autophagy inhibitor. Ammonium chloride is a pH-regulating quaternary ammonium compound that causes intracellular alkalosis and metabolic acidosis, thereby affecting enzyme activity and influencing processes in biological systems. Ammonium chloride has potential antimicrobial and antiviral activity and prevents training-induced improvement in mitochondrial respiratory function in the muscle of male rat flounder. It is also used in the treatment of COVID-19 infections.

Anti-COVID-19 of Ammonium chloride

The COVID-19 pandemic has called an urgent need for drug repurposing to improve the outcome of the disease. Quaternary ammonium compounds have been demonstrated to have antiviral effects and may be of use against SARS-CoV-2 infections. In a double-blind, single-centre study, patients with positive COVID-19 PCR test and/or CT results were recruited. Participants in each group were randomly assigned to either the benadryl combination (benadryl + ammonium chloride) plus standard care group or benadryl alone plus standard care group. The primary outcome was all-cause mortality within 30 days of random assignment. Secondary outcomes included viral load, clinical status (assessed with a 5-point ordinal scale), and length of stay of hospitalised patients.

A total of 120 patients participated in the trial, of whom 60 were assigned to the ammonium chloride group. The results showed no statistical difference between the two groups for the primary endpoint (HR: 3.02 (95% CI, 0.57-16.06; p = 0.195)). Time to recovery and viral load were significantly lower in the ammonium chloride group, with corresponding odds ratios of 1.8 (95% CI, 1.15-2.83; p = 0.01) and 7.90 (95% CI, 1.62-14.17; p = 0.014), respectively. Therefore, caution is advocated in adding ammonium chloride to the standard of care for patients with COVID-19.

References:

[1] ZEINAB SIAMI . Effect of Ammonium Chloride in addition to standard of care in outpatients and hospitalized COVID-19 patients: A randomized clinical trial[J]. International Journal of Infectious Diseases, 2021, 108: Pages 306-308. DOI:10.1016/j.ijid.2021.04.043.