By Matt Perry PharmD
There has been a lot of global attention to the use of the drug hydroxychloroquine as the world attempts to slow the spread of COVID-19 and treat patients infected with this deadly virus. While the FDA here in the United States has suspended to EUA (emergency use authorization) for the drug, many patients may still need education on why this medication is not the answer for COVID-19 treatment and prevention.i
- Brand Name: Hydroxychloroquine is a quinolone also known as Plaquenil.
- Indication: FDA labeled for treatment of lupus erythematosus, malaria and rheumatoid arthritis.
- Dosing: Dosing for lupus erythematosus and rheumatoid arthritis is 200mg to 400mg orally per day. Dosing for malaria prevention is 400mg orally once weekly 1-2 days before travel to risky area and continue for 4 weeks after leaving. Dosing for malaria treatment is 800mg orally once followed by 400mg orally 6 hours, 24 hours and 48 hours after the first dose.
- Drug Interactions: Androgens, antidiabetics, phenothiazines, beta blockers, cardiac glycosides, citalopram (Celexa), cyclosporine, dapsone, escitalopram (Lexapro), haloperidol, mefloquine, MAOs, any QT-prolonging medications, remdesivir, salicylates, SSRIs and tamoxifen.
- Side Effects: At FDA labeled dosing, most common side effect is gastrointestinal upset, particularly diarrhea. Other include skin reactions (psoriasis exacerbation, dermatitis, itching, skin photosensitivity, Stevens-Johnson syndrome and topical epidermal necrolysis), weight loss, anemia, leukopenia, thrombocytopenia, hepatic impairment, angioedema, nervous system effects (ataxia, dizziness, emotional lability, fatigue, headache, irritability, nervousness, nightmares, seizures, psychosis), asthenia, muscle atrophy, ophthalmic changes, deafness, ringing in the ear and bronchospasm.
- Toxicity: Doses higher than labeled doses have shown to cause cardiovascular effects (including cardiac failure, QT prolongation, ventricular arrhythmia and torsades de pointes), bone marrow suppression, severe hypoglycemia, neuromuscular effects, suicidality, and retinal toxicity (blindness).ii
As you can see, while this drug can be safely used at appropriate dosages with the corresponding monitoring in place, the risks to using hydroxychloroquine for an indication or at a dosage not supported by the FDA is extremely dangerous. As we field questions from patients, colleagues, family and friends; we can utilize the facts to help educate and protect them from harm.