Hydroxychloroquine

Hydroxychloroquine is a prescription drug used to treat lupus erythematosus and rheumatoid arthritis. It is sold under the brand name Plaquenil among others. It is also used to prevent and treat malaria, a life-threatening disease transmitted via mosquito bites. It treats malaria by killing the parasites that cause the disease. Although it is not entirely understood how hydroxychloroquine helps patients with lupus and arthritis, researchers know that it somehow helps the body’s immune system deal with the symptoms of these diseases. The drug can cause a range of side effects and interact with other medications.

In 2020 hydroxychloroquine was thrust into the spotlight when some high-profile figures promoted it as a potential treatment for COVID-19, or coronavirus disease 2019. However, this use was largely rejected by the scientific community after several studies showed the drug had no effect on the disease.

Overview

Hydroxychloroquine was derived from the medication chloroquine, a drug capable of fighting malaria that was discovered during a war-time new drug search in the 1940s. Malaria is a deadly disease caused by the Plasmodium parasite. This parasite is carried by the Anophelesmosquito, which is primarily found in sub-Saharan Africa. Over time, people became resistant to chloroquine, so labs developed a new generation of the drug they called hydroxychloroquine, which was approved for medical use in the United States in 1955. This version of chloroquine had fewer side effects and continues to be prescribed to individuals infected with malaria. It is also used as a preventative measure for those who are at risk of being exposed to malaria, such as people traveling to regions of sub-Saharan Africa.

Hydroxychloroquine is also used to treat certain autoimmune disorders, specifically lupus and rheumatoid arthritis. Lupus is a cluster of autoimmune diseases that causes the immune system to become hyperactive and attack healthy tissues inside the body. Rheumatoid arthritis causes long-term joint damage and pain. The drug can also be used to treat a condition known as porphyria cutanea tarda, a disorder caused by low levels of a certain enzyme affecting the skin and nervous system. In this capacity, hydroxychloroquine belongs to the class of medications known as disease-modifying antirheumatic drugs (DMARDs). It has the ability to reduce skin problems in lupus and porphyria patients and can reduce or prevent swelling and pain in arthritic patients.

With the outbreak of the global COVID-19 pandemic in 2020, researchers investigated the potential use of hydroxychloroquine to treat the viral disease. The drug made headlines largely due to controversial comments from US president Donald Trump, Brazilian president Jair Bolsonaro, and others promoting it as an effective treatment or even a cure, despite a lack of strong scientific evidence backing up such claims. Many public health experts warned that more data was needed and that hydroxychloroquine might even be harmful to some COVID-19 patients by causing irregular heartbeat or other problems. In late March 2020 the US Food and Drug Administration (FDA) approved emergency use of the drug as a COVID-19 treatment in hospital settings, but this approval was retracted that June after clinical trials showed no substantial benefits from the treatment in hospitalized patients. Also in June 2020 the World Health Organization (WHO) ended its investigation of hydroxychloroquine as a COVID-19 treatment due to lack of results. The FDA and the National Institutes of Health strongly warn against taking hydroxychloroquine for COVID-19.

Use and Side Effects

Hydroxychloroquine is taken by mouth with food to prevent stomach upset. The dosage and length of treatment depend on the individual. The dosage and duration times are different for patients taking the drug for malaria as opposed to autoimmune problems. Hydroxychloroquine can negatively interact with other medications, so patients should report all medications being taken to a doctor before beginning treatment.

The most common side effects associated with hydroxychloroquine are headache, diarrhea, dizziness, vomiting, and stomach cramps. These side effects are considered mild and usually dissipate within a few days or weeks. Serious side effects may present and should be brought up to a doctor immediately. These include:

• Suicidal thoughts or other mental health effects
• Angioedema (rapid swelling of your skin)
• Vision changes such as blurred vision
• Tightening of muscles in the airway
• Ringing in the ears or hearing loss
• Hair loss or changes in hair color
• Unusual bleeding or bruising
• Severe hypoglycemia
• Blue-black skin color
• Muscle weakness
• Mood swings
• Heart issues
• Sore throat
• Hives

Bibliography

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"FDA Cautions Against Use of Hydroxychloroquine or Chloroquine for COVID-19 Outside of the Hospital Setting Or a Clinical Trial Due to Risk of Heart Rhythm Problems." US Food and Drug Administration, 1 July 2020, www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or. Accessed 16 Sept. 2020.

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"Medicines for the Prevention of Malaria While Traveling: Hydroxychloroquine (Plaquenil)." Centers for Disease Control and Prevention, www.cdc.gov/malaria/resources/pdf/fsp/drugs/Hydroxychloroquine.pdf. Accessed 16 Sept. 2020.

McLaughlin, Eliot C. “Chloroquine and Hydroxychloroquine: What to Know About the Potential Coronavirus Drugs.” CNN, 24 Mar. 2020, www.cnn.com/2020/03/23/health/chloroquine-hydroxycholoroquine-drugs-explained/index.html. Accessed 5 May. 2020.

Park, Alice. “President Trump Called Hydroxychloroquine a ‘Game Changer,’ But Experts Warn Against Self-Medicating with the Drug. Here’s What You Need to Know.” Time, 6 Apr. 2020, time.com/5808894/hydroxychloroquine-coronavirus/. Accessed 5 May. 2020.

Sandhu, Vaneet. "Hydroxychloroquine (Plaquenil)." American College of Rheumatology, Apr. 2020, www.rheumatology.org/I-Am-A/Patient-Caregiver/Treatments/Hydroxychloroquine-Plaquenil. Accessed 16 Sept. 2020.