HydroxyChloroquine (HCQ) in Corona Treatment – Does this really work?

HydroxyChloroquine (HCQ) is basically classified in Anti malarial drug. Anti malarial drugs are those which used in treating Malaria (parasitic infection). HCQ also modifies immune system. So it is also used in immune mediated diseases like Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE).

Currently entire world is facing Corona Virus  – COVID 19 pandemic. Till date we are not able to find out 100% effective anti viral drug against Corona Virus. So we are testingother available drugshoping to work against Corona Virus. Chloroquine and HCQ are examples of such drugs.

Few published articles and interest from US President gain attention ofentire world towards HCQ as a potent treatment option against Corona Virus.

Let’s first see how this drug works against Corona Virus. The mechanism of action is two stepped.

First is blocking acidification of endosomes (human cells) and second is inhibition of virus attachment to ACE2 receptors of human cells. With the help of first mechanism, HCQ works as preventing drug and can be used in Prophylaxis. With the help of first and second mechanisms, HCQ acts against Corona Virus and prevent further complications.

So many countries have started giving HCQ as prophylaxis to their healthcare workers (doctors, nurses) in a hope that HCQ will prevent Corona infection to them. At the same time, doctors have started using HCQ in the treatment protocol for Corona Positive patients.

Like every drug, this drug is also having a lot of side effects. Commonly seen side effects are headache, gastritis, nausea, vomiting, decreased appetite, weight loss, ringing sensation in ear (tinnitus), mood swings, hair fall etc. But the most worrisome side effect is cardiac toxicity. HCQ can cause QTc prolongation, arrhythmia, heart block, sudden cardiac arrest, palpitations, hypotension, myocardial ischemia and infarction etc. Ask a pulmonologist if you develop any of this side effect.

All these cardiac side effects are acute, sudden in onset. They are life threatening too. So one should weigh risk benefit ratio before starting HCQ as Corona prophylaxis or as Treatment.

In some small single hospital studies from US and Italy , the death rate suddenly increased after starting HCQ. The analysis revealed that almost all patients are died because of cardiac complications. There are main two reasons for this unwanted outcome.

 

First is concomitant use of Azithromycin. In COVID 19 patients, Azithromycin is also used to cover secondary bacterial infection. It is given in almost all COVID 19 patients. This Azithromycin also causes QTc prolongation, cardiac side effect. So when these patients receive HCQ, magnitude of cardiac side effects increased and chances of sudden cardiac arrest are high.

Second is underlying poor cardiac condition. Many COVID positive patients are old age (more than 60 years), having diabetes, hypertension, chronic kidney diseases, previous heart diseases, heart failure etc. Almost all will have compromised cardiac functions. So when they receive HCQ, further deterioration of cardiac functions occur which ultimately lead to severe cardiac side effects and death.

So one should decide use of HCQ as prophylaxis and treatment cautiously.

At present many hospitals follow below mentioned guidelines for HCQ in COVID 19 situation.

Guidelines for HCQ use as Corona Prophylaxis –

1)    Risk benefit ratio along with side effects should be explained indetail to healthcare provider.

2)    Baseline ECG (electro cardio gram) should be done in all individuals.

3)    Dose is 200mg twice daily for first day then 200mg once a week for total 6 weeks.

4)    Antacid tablet can be given on empty stomach if individual develops nausea, vomiting or gastritis.

5)    Repeat ECG should be immediately if individual develops palpitations or missed beats.

Guidelines for HCQ use as Corona Virus treatment-

1)    Baseline ECG should be done in all patients. Normal ECG with sinus rhythm is must before starting HCQ.

2)    It should be combined with Azithromycin only in young patients with normal cardiac functions, ECG and absence of co-morbidities like diabetes, hypertension, kidney diseases etc.

3)    Better to avoid concomitant Azithromycin to the patients above 60 years of age.

4)    Once started, ECG should be monitored daily.

5)    Dose is 200mg twice daily for 5-7 days based on clinical response.

6)    After starting HCQ if patient develops abnormality in ECG, HCQ should be stopped immediately.

7)    Oncestopped, HCQ should not be re challenged.

So in summary, use of HCQ should be under observation of doctor. One should ask a doctor if any side effect appear. Patient should discuss in detail about side effects before starting this drug.