Hours of Operation

Monday - Friday: 9 am to 6 pm
Saturday: 9 am to noon
Closed Sundays and holidays

Please follow & like us!
Follow by Email
Facebook
Twitter
RSS Feed
Subscribe by email
Get new posts by email:
Archives

What is Up with Hydroxychloroquine? By Our Student Pharmacist, Ryan Peterson.

2019-coronavirus

With the ongoing COVID-19 pandemic, there has been much speculation about the use of hydroxychloroquine from public officials and in the media. Therefore, with all the information floating around, it is important to separate fact from speculation.

What is hydroxychloroquine?

First approved for medical use in the United States in 1955, hydroxychloroquine is used for the short-term treatment of malaria and the long-term treatment of various autoimmune diseases such as lupus, rheumatoid arthritis, and dermatomyositis. Hydroxychloroquine is marketed under the trade name Plaquenil.

Does hydroxychloroquine work against COVID-19?

The short answer is possibly.  Hydroxycholoroquine has been shown to have direct antiviral activity against SARS-CoV-2 (COVID-19) in a petri dish in a laboratory under controlled conditions. Several small clinical trials looking at whether hydroxycholorquine works have led to conflicting results.  Two small studies1,2 in China found that hydroxychloroquine either aloneor in combination with azithromycinappeared to be associated with a more rapid decline in viral RNA.  However, another small observational studyin patients with more severe illness did not suggest rapid viral RNA clearance after treatment with hydroxychloroquine and azithromycin. Multiple trials evaluating hydroxychloroquine for COVID-19 treatment are underway.

MW-IC064_corona_20200311170341_ZQ

Has hydroxychloroquine been shown to prevent COVID-19?

No medication including hydroxychloroquine is known to be effective for preventing COVID-19.  Clinical trials are ongoing to determine whether hydroxychloroquine should be used in post-exposure prophylaxis for household contact and in healthcare workers. It has been suggested that neither hydroxychloroquine nor any other medication be used for COVID-19 prophylaxis outside of clinical trials. 4

Why is there hesitation among clinicians to use hydroxychloroquine?

There are three main reasons physicians are hesitant about the use of hydroxycholoroquine in COVID -19 patients: 5

  1. Hydroxychloroquine is associated with significant side effects. In many patients, the potential side effects outweigh the benefits of the medication which is a major reason why the drug has not been used.
  2. Hydroxychloroquine is a critical drug used for the treatment of malaria and other diseases throughout in the world. A surge in the use of hydroxychloroquine or use in unapproved indications (including COVID-19) can create major drug shortages.
  3. While clinicians are hopeful that hydroxychloroquine will work to treat COVID-19, they do not have enough evidence at this time to say whether it does or not. Asking a patient to take a medication that can cause significant side effects and has yet to be proven beneficial is very difficult except in extreme cases.

What side effects are associated with hydroxychloroquine?

Patients taking hydroxychloroquine have reported numerous side effects.

These include:

  • dizziness
  • fatigue
  • headache
  • anxiety
  • weight loss
  • diarrhea
  • hair and skin discoloration
  • hair loss
  • nausea and vomiting

Additionally, hydroxychloroquine has been associated with heart problems that make it harder to pump blood to the rest of the body and can lead to heart failure. 6

It is often recommended that before patients take hydroxychloroquine they receive genetic testing.  Patients taking hydroxychloroquine with a mutation leading to a particular enzyme, G6PD, being deficient are at a higher risk to develop a condition called hemolytic anemia where the body destroys red blood cells faster than they are made.

Can I get hydroxychloroquine?

Hydroxychloroquine is a prescription only medication.  The Food and Drug Administration (FDA) issued an emergency use authorization to allow the use of hydroxychloroquine and other agents in adolescents or adults hospitalized for COVID-19.7 Additionally, the Ohio Board of Pharmacy issued an emergency rule8  regarding the dispensing of hydroxychloroquine. According to the rule, new prescriptions of hydroxychloroquine are limited to a 14 day supply and must contain the patient’s diagnosis. Prescriptions written for a COVID-19 diagnosis must have documented a positive test result on the prescription. Additionally, prescriptions for either patients believed to be positive with COVID-19 or prophylactic use is strictly prohibited.

coronavirus symptoms

References:

  • Gautret et al. Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020 DOI:10.1016/j.ijantimicag.2020.105949.
  • Molina JM,et al. No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection. Medecine et Maladies Infectieuses,
  • Chen J,et al. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19). Journal of Zhejiang University, 2020.
  • Coronavirus disease 2019 (COVID-19). Updated April 2020. Available at Uptodate.com. Accessed April 7, 2020.
  • Cortegiani, A. et al. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19, Journal of Critical Care, In Press 2020. https://doi.org/10.1016/j.jcrc.2020.03.005
  • LexiDrugs. Hydroxychloroquine. Updated March 2020. Accessed on April 7, 2020
  • US Food and Drug Administration. https://www-fda-gov.proxy.lib.ohio-state.edu/media/136534/-download. Accessed on April 7, 2020
  • State of Ohio Board of Pharmacy. ORC 4729-5-30.2 – Prescription requirements for chloroquine or hydroxychloroquine. Updated March 26, 2020.

 

Post to Twitter

Leave a Reply