- Nov 10, 2019
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- Moderator
- #381
Quite true, to an extent, and so is this partial excerpts from :Plaquenil (hydroxychloroquine sulfate) dose, indications, adverse effects, interactions... from PDR.netHydroxychloroquine, sold as Plaquenil, is a very safe drug. It has been in use with many malaria, lupus and rheumatoid arthritis patients for decades. The question is whether it is effective against COVID-19. It might help to take a step back and look at terminology:
"Anecdotal evidence," in science, means evidence of an outcome not covered in a repeatable trial. It doesn't mean "out of left field," and the casual use of anecdotal evidence to indicate something with less credibility than a rumor isn't the same thing. Chloroquine is a toxic substance used to treat drug-resistant malaria cases, as a preferred alternative to letting the patient die. It is also used in fish tank cleaners. Not the same thing as hydroxychloroquine.
Medicine is the most primitive of our sciences, and one reason is that it is part science, part art. When science fails, the physician is left with art. When chemoradiation failed with my bladder cancer, my oncologist and I discussed alternatives. He had read the preliminary literature on a drug used for other purposes which he felt might work on my cancer; I read the material and concurred. I was recently discharged as cancer-free. Sometimes, when science cannot give a physician the answers he wants to have, the physician has to turn to art. What has worked under what circumstances with what kinds of patients with what symptoms in the past, and is there evidence of success in situations similar to those involving me and this patient? If the choices are between near-certain death and using a safe pill that will probably work, a physician's choice is pretty clear. That does not mean the physician believes that the drug has been proven effective to the gold standard of success in multiple repeatable trials. Thousands of physicians around the world treating hundreds of thousands of patients are prescribing hydroxychloroquine wearing their "artist" hat, not their "scientist" hat.
In the 1980s, after medical school, I was practicing psychiatry in Europe and became aware that manic-depressive patients, now called bipolar, were getting relief from use of anticonvulsants. I read the limited literature, talked with pharmacists and neurologists, and concluded that anticonvulsants were worth a try, because the alternative was antipsychotics, all of which had serious, bad side-effects. I explained my rationale to my patients, and prescribed the safest, oldest, anticonvulsants I could find for some bipolar patients. Today, anticonvulsants are proven to work in patients with bipolar disorder. The oath I took begins "First, do no harm." It does not begin, "First, do nothing."
COMMON BRAND NAMES
Plaquenil, Quineprox
INVESTIGATIONAL USE: For the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection†, the virus that causes coronavirus disease 2019 (COVID-19)†.
CONTRAINDICATIONS / PRECAUTIONS
Accidental exposure, children, infants, neonates
The safety and efficacy of the chronic use of hydroxychloroquine for systemic lupus erythematosus and juvenile idiopathic arthritis in children and infants have not been established. Children are especially sensitive to the 4-aminoquinoline compounds. Fatalities have been reported after accidental exposure of chloroquine; some cases involved relatively small doses (e.g., 0.75 g or 1 g in a 3-year-old child). Strongly warn patients to keep hydroxychloroquine out of the reach of pediatric patients, including neonates, infants, children, and adolescents.
Bradycardia, cardiac arrhythmias, cardiac disease, coronary artery disease, females, geriatric, heart failure, hypertension, hypocalcemia, hypokalemia, hypomagnesemia, long QT syndrome, malnutrition, myocardial infarction, QT prolongation, thyroid disease
Hydroxychloroquine prolongs the QT interval. Obtain a pre-treatment QTc using a standard 12-lead ECG, telemetry, or mobile ECG device. Obtain baseline electrolytes, including calcium, magnesium, and potassium. Determine if the patient is currently on any QT-prolonging medications that can be discontinued. Document high-risk cardiovascular and comorbid conditions. If the baseline QTc is 500 msec or more and/or the patient has an inherent tendency to develop an exaggerated QTc response (i.e., change of 60 msec or more), correct contributing electrolyte abnormalities, review and discontinue other unnecessary QTc prolonging medications, and proceed with close QTc surveillance. Obtain an initial on-therapy QTc approximately 2 to 4 hours after the first dose and then again at 48 and 96 hours after treatment initiation. If the baseline QTc is 460 to 499 msec (prepubertal), 470 to 499 msec (postpubertal males), or 480 to 499 msec (postpubertal females), correct contributing electrolyte abnormalities, review and discontinue other unnecessary QTc prolonging medications, and obtain an initial on-therapy QTc 48 and 96 hours after treatment initiation. If the baseline QTc is less than 460 msec (prepubertal), less than 470 msec (postpubertal males), or less than 480 msec (postpubertal females), correct electrolyte abnormalities and obtain an initial on-therapy QTc 48 and 96 hours after treatment initiation.[65170] Use hydroxychloroquine with caution in patients with cardiac disease or other conditions that may increase the risk of QT prolongation including cardiac arrhythmias, congenital long QT syndrome, heart failure, bradycardia, myocardial infarction, hypertension, coronary artery disease, hypomagnesemia, hypokalemia, hypocalcemia, or in patients receiving medications known to prolong the QT interval or cause electrolyte imbalances. Females, geriatric patients, patients with diabetes, thyroid disease, malnutrition, liver impairment, or those who drink alcohol to excess may also be at increased risk for QT prolongation.[28432] [28457] [41806] [56592] [56959] [56961] [56963] Consider chronic toxicity when conduction disorders (bundle-branch block, AV block) or biventricular hypertrophy are diagnosed. If cardiotoxicity is suspected, prompt discontinuation of hydroxychloroquine may prevent life-threatening cardiac complications.[41806]
ADVERSE REACTIONS
Severe
cardiomyopathy / Delayed / 0-1.0
hepatic failure / Delayed / 0-1.0
suicidal ideation / Delayed / 0-1.0
macular degeneration / Delayed / Incidence not known
visual impairment / Early / Incidence not known
retinopathy / Delayed / Incidence not known
corneal opacification / Delayed / Incidence not known
toxic epidermal necrolysis / Delayed / Incidence not known
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) / Delayed / Incidence not known
bronchospasm / Rapid / Incidence not known
Stevens-Johnson syndrome / Delayed / Incidence not known
exfoliative dermatitis / Delayed / Incidence not known
erythema multiforme / Delayed / Incidence not known
angioedema / Rapid / Incidence not known
porphyria / Delayed / Incidence not known
acute generalized exanthematous pustulosis (AGEP) / Delayed / Incidence not known
aplastic anemia / Delayed / Incidence not known
agranulocytosis / Delayed / Incidence not known
hearing loss / Delayed / Incidence not known
torsade de pointes / Rapid / Incidence not known
ventricular tachycardia / Early / Incidence not known
ventricular fibrillation / Early / Incidence not known
pulmonary hypertension / Delayed / Incidence not known
AV block / Early / Incidence not known
heart failure / Delayed / Incidence not known
seizures / Delayed / Incidence not known
I am no druggist or doctor of any type, and I didn't stay in a Holiday Inn Express last night, but I do check the PDR before starting a course of medications and am able to discuss with doctor if necessary. If he evaluates, knowing my honest medical history (which is actually pretty bland reading, unless looking at my shot record) and recommends starting a course for treatment of Covid-19, I will take it. FDA says it is an investigational drug that can be prescribed in the treatment of Covid-19. It obviously is not for everyone. Trump's recommendation is certainly not worth considering.