Hydroxychloroquine (Plaquenil): Uses, Precautions, Covid Effectiveness

New drugs continue to appear on the market, but it is also just as common for medical specialists to discover new uses for the already discovered medications. Hydroxychloroquine is a widely used immunomodulatory and antimalarial drug that has been used by humanity for several decades. The drug has proven itself particularly effective in the treatment of some autoimmune diseases and malaria. Now potential new uses are appearing, including its influence on COVID-19. In this article, you can learn more about this drug, how it is used, its precautions, and whether it can be helpful in treating coronavirus.

The role of medication in history

Malaria has taken the lives of numerous soldiers before the discovery of antimalarial drugs before World War II. Those deployed to the South Pacific part of the world were particularly prone to contracting the disease, so it was essential to discover an effective solution.

The first attempts at developing the drug led to the discovery of quinacrine, but the problem was that this substance caused a range of side effects, such as yellowing of the skin. Thanks to the extensive research held by medical specialists, another compound was derived from quinacrine and it was named chloroquine. Field testing of this substance took place in 1943 and soldiers of the US Army took the new drug. In 1955, a safer and more advanced modification called hydroxychloroquine became available to the public.

As the drug was actively consumed by a large number of soldiers during World War II, it was noticed that hydroxychloroquine was effective not only in the treatment of malaria but also in lupus and inflammatory arthritis. After this discovery, reports have been made on the new uses of medication. Now, this antimalarial medication is widely prescribed as the treatment of autoimmune diseases that include the following:

  • systemic lupus erythematosus
  • discoid lupus erythematosus
  • rheumatoid arthritis (in individuals who didn’t react to other treatments)

The use of the drug for the mentioned health problems was approved by the US Food and Drug Administration. In the case of autoimmune diseases, the medication works by reducing the activity of the immune system and thus allowing the body to function properly despite the chronic disease.

How to take Hydroxychloroquine

As the drug has several uses, the dosage necessary for the treatment varies. A consultation with the medical specialist is important to avoid any potential side effects.

In the case of malaria prevention, the first dosage of the drug should be consumed before you come in any contact with the infected mosquitos. Adults are recommended to take a single tablet of hydroxychloroquine one week before their trip to the area where malaria can be contracted. It is essential to take one tablet a week on the same day as the first dosage the entire time you stay in the area. After you come back, you should continue taking this drug for 4 weeks.

When it comes to the treatment of malaria, your first tablet should be taken right when you realize that you contracted this disease. The next dose is administered 7-8 hours later and you should take hydroxychloroquine for the next two days.

As for children, the amount of this drug is directly correlated to the child’s weight, so it’s important for the doctor to calculate the right dosage.

The treatment of lupus and rheumatoid arthritis usually requires taking a single tablet of hydroxychloroquine once or two times a day depending on the severity of symptoms.

The tablets should be swallowed whole, so avoid crushing or chewing them. It is recommended to take the drug with food or with milk to prevent nausea.

What about the use of hydroxychloroquine to treat COVID-19?

The pandemic of COVID-19 caused the medical industry to not only actively work on developing new drugs and vaccines, but also take a second look at a wide range of medications that have been used for years. The same can be said about hydroxychloroquine.

There have been a number of studies conducted by respectable organizations to see the influence of this drug on the virus. At the moment, there can be found 43 reports focused on the use of hydroxychloroquine in patients diagnosed with COVID-19. 25 of these reports showed positive clinical efficacy from the administration of the antimalarial drug to individuals that have been diagnosed with COVID-19. Another important thing to mention is that there have been no worsening trends noticed in any studies, including those that showed no effect.

The findings of medical professionals clearly show the safety and effectiveness of hydroxychloroquine in the treatment of COVID-19 and suggest that this drug should be readily available for doctors that choose to prescribe it. The doctors also mention that early administration of this drug provides consistent clinical efficacy. The drug is currently considered safe for the use against COVID-19 by many medical specialists and there is enough evidence of its effectiveness in the treatment of viral infection.

Other benefits associated with hydroxychloroquine

During the years of drug administration, it has also been unexpectedly discovered that the consumption of hydroxychloroquine led to several metabolic benefits. According to the research conducted by Baltimore Lupus Cohort, the drug reduced thrombosis in patients with lupus. Also, it was noticed that those taking this medication started having better lipid profiles and reduced blood glucose levels. The use of hydroxychloroquine is associated with total cholesterol reduction, which is highly important for a person’s overall health.

Drug interactions to keep in mind

Drug interactions are one of the most common causes of side effects in patients. Individuals who take several drugs at a time often don’t consult medical specialists to see whether such medications can be taken together. There are ingredients that should never be taken together with others. Hydroxychloroquine is not an exception, as it can dangerously interact with a wide range of medications.

Make sure that you tell your doctor if you take any of the following:

  • digoxin
  • phenytoin
  • acetaminophen
  • moxifloxacin
  • azithromycin
  • valproic acid
  • cyclosporine
  • cimetidine
  • tamoxifen
  • methotrexate

The list also includes oral drugs for diabetes or insulin, some drugs that treat irregular heartbeat, and medications for seizures. Antacids should be taken 4 hours after or before taking hydroxychloroquine. Also, if you need to take ampicillin, you should make sure that you do this 2 hours before or 2 hours after taking hydroxychloroquine.

This is not the full list of potential interactions, so consulting your doctor before you take hydroxychloroquine is important.

Does the drug have any contraindications?

Hydroxychloroquine is a safe and effective drug, but this still doesn’t mean that it can be taken by everyone. There are no medications in the world, even the most natural ones, that can be taken by every individual, as individual sensitivity, health problems, and allergies may not coexist with the consumption of certain drugs.

When it comes to hydroxychloroquine, there are a number of diseases that may prevent you from taking this drug. You should always inform your doctor if you are diagnosed with any of these health problems:

  • heart disease
  • seizures
  • liver disease
  • diabetes
  • irregular heartbeat
  • G-6-PD deficiency
  • kidney disease
  • vision problems
  • prolonged QT interval
  • dermatitis

Your doctor can evaluate your current state and decide whether taking hydroxychloroquine will be beneficial based on your particular medical history. It is also important to tell a medical specialist if you drink an excessive amount of alcohol, have any allergies, or have reduced levels of potassium or magnesium in the blood.

If you have previously consumed primaquine or chloroquine and experienced any vision changes, you should tell your doctor. Such drugs fall in the same category as hydroxychloroquine, so you may be at a higher risk of developing the side effect related to vision.

If you are breastfeeding or pregnant, you also need to tell your doctor. If you get pregnant while taking the drug, make sure to inform a specialist as soon as you find out.

Side effects of hydroxychloroquine

Hydroxychloroquine can cause side effects in some patients with individual sensitivity and those who take a higher dosage than necessary. If you notice any severe adverse reactions after taking this drug, you should stop taking it immediately and get emergency medical help.

The side effects may include such:

  • loss of appetite
  • dizziness
  • diarrhea
  • nausea
  • vomiting
  • rash
  • headache
  • stomach pain

In the case of milder symptoms, such as headache or nausea, you should inform your doctor that may adjust your dosage or choose a different drug.

Symptoms that require immediate medical attention include such:

  • vision changes
  • blurred vision
  • light sensitivity or seeing flashes
  • muscle weakness
  • difficulty hearing
  • convulsions
  • irregular heartbeat
  • fainting
  • sudden mood changes
  • ringing in ears

Overdosing can cause the mentioned serious side effects, so if you accidentally consume more tablets than prescribed, don’t hesitate to get medical assistance.

Additional precautions you need to follow

You can never be too safe when it comes to your health, so here are additional precautions that you should know if you take hydroxychloroquine:

  • Properly store your drug

Safe storage is one of the steps that people often underestimate. To make sure that your drug remains effective and won’t expire before its time, you should keep it away from the sources of moisture and heat. It should be kept at room temperature in its original tightly closed container.

Also, it is highly important to keep the drug out of reach of children and pets. The drug doesn’t come in a child-resistant container, so make sure you keep it in a safe place out of sight.

  • Use a medicine take-back program

The best way to dispose of the drugs is via a medicine take-back program that you can learn about from your doctor or pharmacist. In this way, you can ensure that drugs won’t be accidentally consumed by anyone.

  • Don’t make up for a forgotten dose

Just like with any drugs, if you miss a dosage of hydroxychloroquine and remember the next day, it is important that you don’t take two tablets at once to make up for the missed one. This can cause overdosing.

  • Undergo regular eye exams

The prolonged consumption of hydroxychloroquine is associated with the potential risk of vision changes. Patients that take this drug for a long time should undergo frequent eye exams. If you notice any visions changes regardless of how long you have been taking hydroxychloroquine, you should inform your doctor immediately.

  • Have a list of drugs that you take

You should always have a written list of any medications, vitamins, and herbal supplements that you take. It is a good idea to always have this list with you when you visit a doctor or in the case that you are admitted to a hospital. It is easy to forget some drugs that you take when you are asked during an appointment and having the list will prevent potential drug interactions.

An essential medication that saved millions

Hydroxychloroquine is one of those medications that has played a significant role in human history. Being developed many years ago, it still continues to be a widely used medication that treats and prevents dangerous conditions. Its use for malaria already saved millions of lives, so it’s surely a medication that can be considered essential for humanity. It provides relief to a huge number of people diagnosed with lupus and rheumatoid arthritis, so its importance in modern times cannot be underestimated. Now, in the times of the COVID-19 pandemic, the drug seems to be showing effectiveness in the early stages of the treatment. While further research is required, it is surely interesting to see how many other uses of hydroxychloroquine are still waiting to be uncovered.