When it comes to COVID-19, President Trump has called chloroquine and hydroxychloroquine “game-changers,” while Dr. Fauci at the same time has said “there is no magic drug.”

The reason why there is potential promise in these drugs is that because in labs, meaning in a test tube, they’ve been shown to be effective against the old SARS virus, and possibly against the new SARS virus, meaning SARS-CoV-2, the virus that causes Covid-19. And for this reason, there is now a high demand for these drugs. 

And as a result of this high demand, some people who take these drugs for other medical conditions, like lupus or rheumatoid arthritis, are having a hard time getting new prescriptions.

So in this video, I’m going to dissect these drugs in further detail, and then explain their potential for preventing and/or treating COVID-19.

What is Chloroquine and Hydroxychloroquine?

Chloroquine, which is available in 250 mg and 500 mg tablets, is an old drug that has been used to prevent and treat malaria. 

Chloroquine and Hydroxychloroquine for Coronavirus (COVID-19)?

Chloroquine and Hydroxychloroquine for Coronavirus (COVID-19)?YouTube Link: https://youtu.be/Kdye8z1GoNE When it comes to COVID-19, President Trump has called chloroquine and hydroxychloroquine “game changers,” while Dr. Fauci at the same time has said “there is no magic drug.” The reason why there is potential promise in these drugs is that because in labs, meaning in a test tube, they’ve been shown to be effective against the old SARS virus, and possibly against the new SARS virus, meaning SARS-CoV-2, the virus that causes Covid-19. And for this reason, there is now a high demand for these drugs. And as a result of this high demand, some people who take these drugs for other medical conditions, like lupus or rheumatoid arthritis, are having a hard time getting new prescriptions. So in this video, I’m going to dissect these drugs in further detail, and then explain their potential for preventing and/or treating COVID-19. What is Chloroquine and Hydroxychloroquine? Chloroquine, which is available in 250 mg and 500 mg tablets, is an old drug that has been used to prevent and treat malaria. HCQ, which is structurally very similar to chloroquine, is used to treat rheumatologic conditions such as lupus and rheumatoid arthritis, and is available in 200 mg tablets. For patients who require HCQ for the chronic treatment of rheumatologic disease, the maximum recommended daily dose is 5 mg/kg/day of actual body weight. So for example, if someone weighs 80 kg, that would be 400 mg per day. Both Chloroquine and hydroxychloroquine affect the innate immune system, and alter inflammation, although exactly how they do so remains unknown. What are the side effects of Chloroquine and Hydroxychloroquine? Overall, these drugs are considered very safe, as serious side effects are extremely rare. An itchy, maculopapular skin rash (reaction) occurs in about 10% of patients treated with chloroquine or HCQ. One known side effect of these medications with long term use is eye damage, specifically damage to the retina of the eye. That is why we always monitor patients with routine eye exams whenever starting these medications for long term use. With that said, Serious eye damage is relatively rare. Chloroquine can prolong the QTc interval on the EKG, and when there is prolonged QTc interval, there is a relatively higher risk of having a fatal arrhythmia, but overall, the risk of having a fatal arrhythmia from chloroquine by itself is very low. However, the risk is increased if someone is taking other medications that prolong the QTc interval. And HCQ does not prolong the QTc interval, so it by itself does not cause fatal arrhythmias. Can Chloroquine and Hydroxychloroquine be Used For COVID-19? Hydroxychloroquine is being studied to determine if it can be used to prevent and/or treat COVID-19. Trump claims that because the drug has been in use for years, it potentially poses fewer risks than a newly developed drug. And I can tell you that overall, they are both generally safe drugs, with HCQ being considered the safer of the two. But we don’t know if it's necessarily safe for patients with COVID-19 patients, because it has been studied in a clinical trial. Besides answering the question, is it safe in patients with COVID-19, we have to know if it's effective in patients with COVID-19. Why are these drugs thought to help fight COVID-19? There was a study in China that was published in the Journal of Bioscience Trends this month, which demonstrated that chloroquine seems to improve COVID-19-associated pneumonia, and it appeared to be safe in these patients as well. Chloroquine appears to have broad-spectrum antiviral properties, and this is why it is considered a Covid-19 treatment in China. But this was a small study and while it looks like there might be some promise, it's far from certain that it is effective against COVID-19. Regarding hydroxychloroquine in combination with the antibiotic azithromycin, there was a single "small study" that showed that the combination of these two medications seemed to help against Covid-19.Even if this combination does work, extra precaution has to be taken because when these meds are given together, they can alter the heart's electrical activity. Specifically, they can prolong the QT interval, which can lead to a fatal arrhythmia.

Posted by Doctor Mike Hansen on Friday, April 3, 2020

HCQ, which is structurally very similar to chloroquine, is used to treat rheumatologic conditions such as lupus and rheumatoid arthritis, and is available in 200 mg tablets.

For patients who require HCQ for the chronic treatment of rheumatologic disease, the maximum recommended daily dose is 5 mg/kg/day of actual body weight. So for example, if someone weighs 80 kg, that would be 400 mg per day. 

Both Chloroquine and hydroxychloroquine affect the innate immune system, and alter inflammation, although exactly how they do so remains unknown.

What are the side effects of Chloroquine and Hydroxychloroquine?

Overall, these drugs are considered very safe, as serious side effects are extremely rare.  

The most common side effects are related to the gastrointestinal tract, skin, brain, and eyes. 

Although they are both generally considered very safe, HCQ has fewer side effects compared to chloroquine. 

Upset stomach is the most common side effect, and is the most common reason why patients stop taking these medications. Besides an upset stomach, they can cause nausea and diarrhea. These symptoms are more common with chloroquine than HCQ.

Sometimes these drugs can cause headache, and lightheadedness as well. Both of these effects typically disappear spontaneously within several weeks of taking the medication. Very rarely does chloroquine cause seizures. 

An itchy, maculopapular skin rash (reaction) occurs in about 10% of patients treated with chloroquine or HCQ.  

One known side effect of these medications with long term use is eye damage, specifically damage to the retina of the eye.  

That is why we always monitor patients with routine eye exams whenever starting these medications for long term use. With that said, Serious eye damage is relatively rare. 

Chloroquine can prolong the QTc interval on the EKG, and when there is prolonged QTc interval, there is a relatively higher risk of having a fatal arrhythmia, but overall, the risk of having a fatal arrhythmia from chloroquine by itself is very low.

However, the risk is increased if someone is taking other medications that prolong the QTc interval.

And HCQ does not prolong the QTc interval, so it by itself does not cause fatal arrhythmias.

Can Chloroquine and Hydroxychloroquine be Used For COVID-19?

Hydroxychloroquine is being studied to determine if it can be used to prevent and/or treat COVID-19.

Trump claims that because the drug has been in use for years, it potentially poses fewer risks than a newly developed drug. And I can tell you that overall, they are both generally safe drugs, with HCQ being considered the safer of the two.

But we don’t know if its necessarily safe for patients with COVID-19 patients, because it has been studied in a clinical trial. Besides answering the question, is it safe in patients with COVID-19, we have to know if its effective in patients with COVID-19. 

Why are these drugs thought to help fight COVID-19?

There was a study in China that was published in the Journal of Bioscience Trends this month, which demonstrated that chloroquine seems to improve COVID-19-associated pneumonia, and it appeared to be safe in these patients as well.

Chloroquine appears to have broad-spectrum antiviral properties, and this is why it is considered a Covid-19 treatment in China. But this was a small study and while it looks like there might be some promise, it’s far from certain that it is effective against COVID-19.

Regarding hydroxychloroquine in combination with the antibiotic azithromycin, there was a single “small study” that showed that the combination of these two medications seemed to help against Covid-19.

Even if this combination does work, extra precaution has to be taken because when these meds are given together, they can alter the heart’s electrical activity. Specifically, they can prolong the QT interval, which can lead to a fatal arrhythmia.

Now some of you out there might be saying, well why would an antibiotic, meaning azithromycin, work against viruses, when antibiotics only work against bacteria?

And that is a great point. But for some unknown reason, azithromycin seems to have some effect on respiratory viral infections, especially in patients with COPD/emphysema.

But regardless if we are talking about giving someone chloroquine by itself, or HCQ by itself, or HCQ in combination with the antibiotic azithromycin, they all have to undergo a randomized clinical trial that shows they are both safe and effective in patients with COVID-19.

For these reasons, the US Food and Drug Administration has not approved them, despite Trump claiming the agency has done so. Just because it works in a test tube does not mean it will work, or be safe in people.

And Just this week, the state of New York started trials on these drugs, with 750,000 doses of chloroquine, and 70,000 doses of hydroxychloroquine slated to enter this study. Also, Bayer, the drug maker, has donated 3 million doses of chloroquine, to the federal government. 

The FDA is also talking with drug manufacturers about ramping up production of these drugs, not only to handle the surge of COVID-19 infections that are coming but also ensure that people lupus and rheumatoid arthritis can still be prescribed them.

Now if you are attempted to get a hold of chloroquine or HCQ so that you can take it if you have COVID-19, or to have it handy in case you develop COVID-19…….my advice would be….don’t do that.

At least not until its proven safe and effective.

Apparently in Nigeria, there were three overdoses of chloroquine…..although I don’t know what that means, because I don’t know how someone would die of a chloroquine overdose unless it was intentional. But I don’t know any of the details of those cases, so I can’t really comment. 

Also, in Arizona, a man died after reportedly taking a nonmedical form of chloroquine used to fight parasites in aquariums…which is something that no one should ever do.

But hopefully with chloroquine and HCQ, they prove to be safe and effective.

You may recall, there was another drug that initially showed promise for treating Covid-19-patients in China, called lopinavir-ritonavir. But when looked at further in clinical trials, it just did not pan out. 

Also with the new drug Remdesivir, the trials are still pending on whether or not this is a safe and effective drug for COVID-19, so stay tuned on that.

Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

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