HCQS and COVID19

The famed drug in COVID-19: Details unfold

This drug, HCQs have received immense publicity this year in the COVID-19 pandemic. Yes, this was the special drug Trump and the world namely Indonesia, Australia and Germany dialled PM Modi for and made India everyone’s radar for supply of HCQ. This hype had led to inability of people who actually need to find it at the medical store and rapid stocking of the medication among commoners who stocked it or may be had it without proper medical guidance not knowing about the irreversible side effects of the same.

Presently, there is a shortage of HCQswhich indicates that patients taking this medicine are having a hard time getting the required treatment.

Hydrochloroquinone (HCQs) is a common drug known by most that is essentially used in the treatment of malaria. It is a derivative of chloroquine which has fewer side effects. It is also effectively used for autoimmune disease systemic lupus erythematosus (SLE) and rheumatoid arthritis. This hyped drug has multiple benefits in treatment of lupusstarting from decrease of disease flares to delayed absorption of UV light. It has also proven to be beneficial in decreasing the risks of CKD in rheumatoid arthritis patients. But this drug efficacy is not observed effectively in the smoking population.

This drug had been found to be effective on the SARS-CoV-2. It has an inhibitory antiviral effect on the novel virus. This drug had been administered to many affected patients either alone or with azithromycin. This drug had shown to be clinically beneficial in several small single centred studies through significant limitations. On March 28, 2020 FDA had issued Emergency Use Authorization (EUA) of the drug. But this is often misinterpreted. EUA means increase in access to the medicine and not approval for the treatment of COVID-19.

Based on the guidelines provided by ICMR, this was suggested only for frontline asymptomatic workers involved in care of suspected or confirmed cases of COVID-19. The recommended dosage was 400 mg twice a day on the first day followed by 400mg once weekly for the next 7 weeks and medicines was advised to be taken with meals. Contraindications clearly stated retinopathy, hypersensitivity as well as pre-existing cardiovascular problems. ICMR also stated that electrocardiogram (ECG) should be done prior to prescribing HCQ prophylaxis.

There is lack of enough medical data to prove efficacy of HCQs. FDA has issued warning of heart related side effects of drug if administered without medical guidance.

At present there is extremely limited data available to determine the best dosage that can optimize the effect and reduce the side effects. Since much about the novel virus is also yet to be discovered, and it is also unclear whether COVID-19 itself increases the fatality risk.

HCQs like most of the pharmaceutical drugs have mild to adverse side effects that sometimes has added to the fatality of cases. This is the reason why this drug is presently under review to understand its efficacy as well as considering the safety dosage. Some of the enlisted side effects include nausea, abdominal pain, vomiting, hypoglycaemia and cardio-vascular effects. FDA has issued a statement that hydroxychloroquine should not be administered without medical supervision since it may lead to heart rhythm irregularities.

Of late our Health Ministry has also stated the usage of the drug should be restricted to early symptoms in course of the treatment. And should be best avoided for patients with co-existing chronic diseases. This should be followed to achieve a meaningful effect of the drug.

A solidarity trial is ongoing to discover an efficacious treatment against COVID-19 being carried out by WHO and partners. They are currently evaluating the use of HCQs and hence this arm of trial has been paused.

Thus, even doctors and pharmacists are being discouraged presently from inappropriate prescribing of this medication that can prevent medication stockpiling and potential drug shortages. And this would enable patients with SLE and rheumatoid arthritis to fetch the medication and reduce their risk of complications.

HCQs safety in electrolyte abnormality in CKD