What is the difference between chloroquine and hydroxychloroquine?
Both are similar in their actions at the cellular level. However, Hydroxychloroquine is safer then Chloroquine and has fewer side effects. Chloroquine can cause nausea, vomiting retinal toxicity much more severe than hydroxychloroquine. Why is HCQ suddenly in limelight A tweet by President Trump on 21 March 2020 claiming that the combination of HCQ and Azithromycin has a real chance to be one of the biggest game-changers in the history of medicine accelerated the enthusiasm. The result is that these drugs are no longer available with the chemist.
Is there evidence to sup• port te use of H CQ forh Covid 19?
CQ or The data to support the use of these drugs in Covid 19 are limited and inconclusive. Outside the body in laboratories, they were found to be effective against coronavirus and influenza virus. In the
human body their usage seems to be ambiguous.
Since when is this drug available?
This drug was approved by many nations in 1955 for the treatment of malaria. It is one of the safest and most effective drugs available for the treatment of malaria. Besides SLE and Rheumatoid arthritis it is also useful in post Lyme arthritis and Q fever.
What about the study from Rance and China?
One small study from France which was dis-cussed in Annals of Internal Medicine demonstrated benefits. The study was not placebo controlled and had some flaws. A follow up study lacked control group. In another small study from China in mild to moderate cases of Covid 19 found no difference in recovery rates. More than 15 trials are in progress the world over and some strong data is expected in a few weeks.
Hence when is it recommended?
There are no specific recomtnendations by world health authorities so far. It has been used in those who have had active dis-ease.lt has been pre-scribed for asymptomatic health care providers like Doctors and Nurses and paramedics who are the first responders and are involved in the care of suspected or confirmed cases of Covid 19 infections. Asymptomatic household contacts of lab-oratory confirmed cases may be given HCQ, Though recommended it’s utility is still not proved and completely accept-able. The drug is not available for patients of rheumatoid arthritis and systemic lupus erythematosis.
What are the implications?
These patients with arthritis would have exacerbation of their symptoms after stopping the drug.The symptoms may appear after a month or so after stopping the medications. On one hand the drug is being used for a viral infection for which there is no robust evidence and on the other hand patients with some specific forms of arthritis are deprived of this medicine because of hoarding and exports.
What is the dose recommended?
Asymptomatic health care workers involved in the care of suspected or confirmed cases of Covid 19 we suggest 400 mg twice a day on day one, followed by 400 mg once weekly for next 7 weeks to be taken with meals. Asymptomatic household contacts of laboratory confirmed cases should take 400 mg twice a day on day one followed by 400 mg once weekly for next 3 weeks.
What are the precautions?
It should be avoided in individuals with retinopathy or G6PD deficiency. It is not recommended for individuals under 15 years of age. It has a certain drug to drug interactions. Use in pregnancy and nursing mothers is not absolutely safe. If an individual has cardiovascular disease, then the risk benefit ratio needs to be kept in mind.
It is recommended that use of hydroxychloroquine should not instil a sense of false security. Frequent washing of hands, using a mask and social distancing is still more proven then hydroxychloroquine. Only those asymptomatic health care workers involved in the care of suspected or confirmed Covid 19 and asymptomatic house hold contacts of lab-oratory confirmed cases need to be on hydroxychloroquine.
Author: Dr Jay Deshmukh
Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.