Taking Hydroxychloroquine to Prevent Covid-19 Is Dangerous—Here’s What You Can Do Instead
The FDA revoked the emergency use authorization of hydroxychloroquine sulfate and chloroquine for the treatment of Covid-19 as studies began to show the serious risks of the drugs outweighed the benefits. However, there are treatments in the pipeline that may be more effective.
For a time, it was hoped that hydroxychloroquine sulfate and chloroquine, drugs commonly used to treat lupus, rheumatoid arthritis (RA), and malaria, would be key weapons in the fight against Covid-19.
Early anecdotal evidence hinted that hydroxychloroquine may interfere with the virus’s ability to replicate, which, along with the drug’s known anti-inflammatory properties, led to growing enthusiasm. This drug was also widely touted by President Trump, who said he was taking it to prevent Covid-19 infection.
In March 2020 the Food and Drug Administration (FDA) issued an emergency use authorization allowing hydroxychloroquine and chloroquine to be used to treat certain severely ill Covid-19 patients.
This act was not an official nod. It was a way to shortcut red tape and allow severely ill people access to a drug when little else was available or working.
The emergency authorization extended only to hospital patients with severe Covid-19, but many doctors began prescribing it off-label to treat milder cases or possibly prevent infection. As a result, there was concern of drug shortages that could affect people who take hydroxychloroquine or chloroquine to treat lupus or RA. A study in the May 28, 2020, issue of JAMA cited a 2,000-percent uptick in prescriptions for these drugs in March after the president sang their praises for treatment of Covid-19.
But as more data emerged, the FDA rescinded its emergency use authorization on June 15, citing few benefits and substantial risks, including potentially fatal heart rhythm abnormalities—especially in people who also were taking an antibiotic called azithromycin.
This is most likely not the final chapter in this story as clinical trials looking at hydroxychloroquine and chloroquine are still under way and will continue.
What to do now
If you have been taking these medications for Covid-19 outside of a hospital—and hundreds of thousands of people may have been—call your doctor to discuss the next steps right away, says Richard D. Shih, MD, a professor of integrated medical science and program director for the Emergency Medicine Residency Program at the Charles E. Schmidt College of Medicine at Florida Atlantic University in Boca Raton.
“When you look at the risk-benefit ratio now, we are seeing more and more evidence of side effects and potential complications and not much benefit,” Dr. Shih warns. The FDA states that it is OK for people being treated with hydroxychloroquine or chloroquine for severe Covid-19 in the hospital to finish up their course of treatment as long as their doctor agrees.
Mary Crow, MD, chief of rheumatology and director of rheumatology research at the Hospital for Special Surgery in New York City, has been prescribing hydroxychloroquine and chloroquine to her patients with lupus and RA for a long time. She says there is no risk of withdrawal for people with Covid-19 who stop taking hydroxychloroquine under a doctor’s order and guidance. “Stopping it should be no problem at all,” she says. “It probably has not been helping, and we hope it hasn’t been hurting that much.”
Take care of your heart
Hydroxychloroquine doses used to treat Covid-19 were much higher than those typically used for lupus, Dr. Crow notes. The heart risks seen in Covid-19 are rarely reported with lupus and may depend on the amount of the drug that’s taken.
The good news is that heart problems seen in people taking hydroxychloroquine are reversible. “If the medication annoyed your heart’s electrical system and set up the potential for drug-associated heart rhythm disorders, stopping the medication will reverse this risk,” says Michael J. Ackerman, MD, PhD,a genetic cardiologist at the Mayo Clinic in Rochester, Minnesota, who studies the potential heart complications of hydroxychloroquine.
That said, the jury is still out in some ways, and in some individuals with Covid-19, when it comes to the use of hydroxychloroquine. “Reach out to your medical provider because there may be nuances that, for whatever reason in the eye of your provider, you may be getting a benefit not captured in the studies,” Dr. Ackerman says. “If your heart risks are monitored and absent, your doctor may say, ‘Let’s stay the course.'”
The FDA suggests that doctors who are considering use of hydroxychloroquine or chloroquine to treat or prevent Covid-19 do so in the context of a clinical trial, as many are under way.
Caring for Covid-19 patients in the meantime
As researchers are working tirelessly to find new Covid-19 drugs and a possible vaccine, there are things to do today that help prevent and treat Covid-19, according to the Centers for Disease Control and Prevention.
This starts with treating your symptoms. “If you have a fever, take medication to reduce it and make sure you stay hydrated,” says Len Horovitz, MD, a pulmonary specialist with Lenox Hill Hospital in New York City. “Get lots of rest and call your doctor immediately if you have trouble breathing,” he says, noting that there is no quick fix for a coronavirus infection.
You should also follow the CDC’s other instructions, which by now are familiar:
- Practice social distancing
- Wash your hands often with soap for at least 20 seconds
- Don’t touch your face
- Wear a mask when social distancing is not possible
- Every day, clean and disinfect frequently touched surfaces, such as tables, doorknobs, and light switches
- Watch out for Covid-19 symptom such as fever, cough, shortness of breath or other symptoms , and stay home when you are sick.
- Protect your family if you are infected
GEORGE FREY/Getty Images
Exploring the Covid-19 pipeline
The Covid-19 treatment pipeline is robust, Dr. Shih says. “There will be other drugs that come out and likely will be beneficial. We all would love to see a game changer.”
An antiviral drug called remdesivir, which was developed to thwart Ebola and related viruses, also scored emergency use authorization from the FDA for treating Covid-19, and Israel just approved the use of remdesivir for coronavirus infections. The FDA noted that taking hydroxychloroquine with remdesivir could actually cause the latter to be less effective.
Many rheumatic diseases like lupus and RA are inflammatory and occur when the immune system goes rogue and starts attacking your own skin, joints, tissue, or organs. This is why researchers have been trying drugs such as hydroxychloroquine from rheumatologists to treat Covid-19, because much of the damage is thought to be due to inflammation and the immune reaction to the virus.
Severe Covid-19 can kickstart a cytokine storm, a severe immune system reaction that occurs when the body releases a host of inflammatory proteins, called cytokines, where they cause damage, Dr. Crow explains. Many medications, some of which are used to treat RA and related autoimmune diseases, target cytokines implicated in this storm and could be protective if research pans out, she says.
A new study out of the University of Oxford in England suggests that a corticosteroid drug called dexamethasone, which is used in RA, can decrease the risk of death among people with a severe Covid-19 infection who need help breathing. This study is one arm of the RECOVERY (Randomised Evaluation of Covid-19 Therapy) trial, which looks at a range of potential treatments for Covid-19. But Dr. Crow cautions that at least one study in the United States hints that moderate- to high-dose steroid use is associated with a more severe Covid-19 disease course.
Convalescent plasma therapy, which involves taking donated blood from people who have recovered from Covid-19, spinning it in a centrifuge to separate out the clear watery plasma that contains infection-fighting antibodies and infusing the plasma (after it is screened for other infectious agents) into very sick Covid-19 patients, is also showing promise in clinical trials.
- FDA: "Frequently Asked Questions on the Revocation of the Emergency Use Authorization for Hydroxychloroquine Sulfate and Chloroquine Phosphate."
- FDA: "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."
- Richard D. Shih, M.D, professor of integrated medical science; director, Emergency Medicine Residency Program, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
- Journal of the American Medical Association: "Prescription Fill Patterns for Commonly Used Drugs During the Covid-19 Pandemic in the United States."
- Mary Crow, MD, chief of rheumatology; director of rheumatology research, Hospital for Special Surgery, New York City.
- Michael J. Ackerman, MD, PhD, genetic cardiologist, Mayo Clinic, Rochester, Minnesota.
- University of Oxford: "Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of Covid-19."
- CDC: "How to Protect Yourself & Others."
- Len Horovitz, MD, pulmonary specialist, Lenox Hill Hospital, New York City.
- Israel Priminister's Office: "Cabinet Approves Health Minister's Decision on Remdesivir."