• Dan Kao

Why You Should Not Ask For Plaquenil



In the fight against COVID, there seems to be conflicting information by the hour and many treatments are being tried. But one medication has made it out into the mainstream media, as “the” medication to take to treat COVID: Plaquenil. Although it is being used extensively with some promising results [2], Plaquenil is not a drug that magically cures COVID and especially not one that you should be asking for from your doctor to prescribe for you to take home.


In this post, we go into the reasons why.


What is Plaquenil?


Plaquenil, also known as hydroxychloroquine or chloroquine, is a drug commonly used to fight certain types of malaria, lupus, and rheumatoid arthritis. It destroys the malarial parasites by increasing the pH, which interferes with many of its cell functions [1]. This is the mechanism that many think as to why it may be effective against the Coronavirus [2].


In many hospitalized patients, Plaquenil is just one of the medications being used against the fight against COVID. Currently, it is not FDA approved for COVID treatment it has been granted an emergency exemption to be used off-label, as research continues on Plaquenil and other medications like it [3].


Reason 1: Optimal Dosing is still unknown [4]


Whenever we receive a prescription for a medication, it contains an exact dosage along with instructions on when and how to take it. Unfortunately, every drug contains side effects that may harm our bodies or interact with other drugs. Multiple studies are conducted on each drug so that the optimal dose is found where we can benefit the most from it, but also reduce the harm it may have on our bodies.


For Plaquenil there are no studies that have been conducted that look into what the optimal dose is against COVID. Plaquenil has many side effects and interactions with other drugs, and if taken without being carefully monitored in a hospital, it may do your body more harm than good.


Reason 2: Side Effects and Drug Interactions


Plaquenil is known to contain side effects that are more serious than other drugs. Until dosing is found out, it is impossible to know what side effects the drug may have on your body if you take it at home.


Some of the more severe side effects include:


  • Severe drops in blood sugar, which may result in a hypoglycemic coma [5, 6] . This is especially dangerous for those who may have diabetes

  • It may lower the function of your immune system [7], which would help your body fight off infections, or make it a lot harder for those with immunocompromised systems to fight off infections; such as cancer patients.

  • It may cause liver failure if too much is taken [7]

  • Plaquenil, especially with other drugs, may affect your heart beat. It may be worse for those with existing heart conditions [8].


Plaquenil on its own may cause any of those side effects listed above, especially if taken at unsafe dosages. But if combined with certain medications used to treat the heart, liver, or kidneys it may make those side effects worse, at even small doses. Some common medication groups that have interactions with Plaquenil are:


  • Heart medication: Digoxin, amiodarone

  • Insulin/anti-diabetic drugs

  • Antibiotics: azithromycin, moxifloxacin, cyclosporine

  • Anti-epilepsy drugs

  • Cancer treatment drugs


Reason 3: May be dangerous for pregnant women


In previous studies, Plaquenil has been detected in the umbilical cord at levels similar to the mother’s blood level [9]. At smaller doses, Plaquenil has been shown to have little effect on the baby, but in higher doses in animal models, the drug has been found in eye tissue which may affect fetal eyesight [9, 10, 11]. Plaquenil was also found in the breast milk of those breastfeeding [11, 12]. Although no adverse effects have been found, we do not know if there is a certain dosage which may result in side effects and it is best not to take the risk at this time [11, 12].


Conclusion


With COVID remaining in the forefront of the minds of many, it is easy to get lost and connect with the latest headline or what we may have heard. Plaquenil remains just one of the possible treatments in the fight against COVID. Since there is so much to be learned about the virus and the medications being used, it is best to listen to your doctor about what is best for you.


COVID Resources


CDC Coronavirus Page

WHO Coronavirus Page

How to prevent the spread of Coronavirus


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Daniel Kao, AGACNP-BC, is an Acute Care Nurse Practitioner currently practicing in NYC.


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References


  1. Travassos M, Laufer MK. Antimalarial drugs: An overview. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 15, 2019.

  2. Yao, X., Ye, F., Zhang, M., Cui, C., Huang, B., Niu, P., … Liu, D. (n.d.). In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed?term=32150618

  3. Commissioner, O. of the. (n.d.). Coronavirus (COVID-19) Update: FDA Continues to Facilitate Development of Treatments. Retrieved from https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-continues-facilitate-development-treatmentsCommissioner, O. of the. (n.d.). Coronavirus (COVID-19) Update: FDA Continues to Facilitate Development of Treatments. Retrieved from https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-continues-facilitate-development-treatments

  4. https://www.fda.gov/media/136537/download

  5. Cansu DU, Korkmaz C. Hypoglycaemia induced by hydroxychloroquine in a non-diabetic patient treated for RA. Rheumatology (Oxford). 2008; 47(3):378-379. [PubMed 18222983]

  6. Unübol M, Ayhan M, Guney E. Hypoglycemia induced by hydroxychloroquine in a patient treated for rheumatoid arthritis. J Clin Rheumatol. 2011; 17(1):46-47. [PubMed 21169846 ]

  7. FDA Safety Alert, April 1, 2020

  8. Simpson TF, Kovacs RJ, Stecker EC; American College of Cardiology. Ventricular arrhythmia risk due to hydroxychloroquine-azithromycin treatment for COVID-19. Updated March 29, 2020. Accessed March 30, 2020. https://www.acc.org/latest-in-cardiology/articles/2020/03/27/14/00/ventricular-arrhythmia-risk-due-to-hydroxychloroquine-azithromycin-treatment-for-covid-19

  9. Costedoat-Chalumeau N, Amoura Z, Aymard G, et al, "Evidence of Transplacental Passage of Hydroxychloroquine in Humans," Arthritis Rheum, 2002, 46(4):1123-4. [PubMed 11953993]

  10. Levy RA, Vilela VS, Cataldo MJ, et al, "Hydroxychloroquine (HCQ) in Lupus Pregnancy: Double-Blind and Placebo-Controlled Study," Lupus, 2001, 10(6):401-4. [PubMed 11434574]

  11. Motta M, Tincani A, Faden D, et al. Follow-up of infants exposed to hydroxychloroquine given to mothers during pregnancy and lactation. J Perinatol. 2005;25(2):86-89. [PubMed 15496869]

  12. Götestam Skorpen C, Hoeltzenbein M, Tincani A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016;75(5):795-810. [PubMed 26888948]

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