Drugs such as chloroquine, Plaquenil and hydroxychloroquine are still in clinical trials to determine...

Drugs such as chloroquine, Plaquenil and hydroxychloroquine are still in clinical trials to determine their safety and efficacy for COVID-19. Credit: AFP via Getty Images / Gerard Julien

Drugs touted as promising treatments for COVID-19 can cause serious side effects or overdoses without proper medical guidance, doctors say.

Approved for use in treating malaria and autoimmune diseases, doctors are prescribing them to stave off and treat COVID-19 even though they are still in clinical trials to determine their safety and efficacy for that use. The FDA has not approved these drugs for COVID-19, but doctors can prescribe them anyway since they are approved for other purposes. 

Hydroxychloroquine could cause fatal heart arrhythmias, especially in people with underlying heart disease, doctors said. And its older, more toxic cousin chloroquine, can poison users who take too much. An Arizona man died recently after ingesting a fish tank cleaner that contained a version of the drug that is toxic to humans.

Dr. Bruce Hirsch, an infectious disease specialist with Northwell Health, said he’d advise anyone “at any risk for heart disease” to get a baseline electrocardiogram, or EKG, before taking hydroxychloroquine.

“The medication can slow the conduction of electrical messages in the heart and, if given along with azithromycin, that effect can be even worse,” he said. The antibiotic azithromycin is used with the hydroxychloroquine to treat COVID-19. “People who have problems where baseline conduction is slow should be particularly careful about taking medications that slow it further.”

He said such patients would be particularly vulnerable to a sometimes fatal heart rhythm irregularity, a ventricular tachycardia called torsade de pointe.

The drug, brand name Plaquenil, is generally well tolerated, especially for short term use, doctors said.

Patients with stable liver, kidney or other diseases should be able to tolerate it short term, said Hirsch. Rarely, someone could develop anemia even with one dose, he said, while more common side effects are stomach cramps or nausea.

Patients with advanced liver or kidney disease should consult physicians. 

Long-term use can cause retinal damage, and Dr. Julie Nusbaum, a rheumatologist at NYU Winthrop Hospital, said he patients with autoimmune diseases like lupus are advised to get an annual eye exam. She suggested that people with retinal disease talk to their ophthalmologist before taking the medication for COVID-19, although she was less concerned with short term use.

Some, but not all, COVID-19 patients in a small French study showed improvements with hydroxychloroquine plus azithromycin , which is also in clinical studies in China. A promising experimental antiviral drug Remdesivir made by Gilead Sciences is also now in widening trials. 

New York State will be receiving hundreds of thousands of doses for use on COVID-19 patients in a state with a surging rate of infection and fears that hospital intensive care units will be unable to handle the influx of dangerously ill patients needing respirators to survive. It is receiving 10,000 doses of Zithromax, 70,000 doses of hydroxychloroquine, and 750,000 doses of chloroquine, for use in wide-scale studies in treating patients here. Nigeria just warned its citizens about using chloroquine on their own after three people were hospitalized with overdoses.

The Arizona man who died, and his wife who was hospitalized, were healthy and in their 60s when they poured a fish tank cleaner into soda after seeing it contained the ingredient chloroquine phosphate. They thought it was the same drug touted by President Donald Trump to prevent or treat COVID-19,  the woman said in interviews from the hospital. The chloroquine phosphate used to kill aquatic parasites is formulated differently than the medicinal version and is toxic to humans.

Autoimmune patients who use Plaquenil as the backbone of their treatment to control chronic diseases like lupus are finding it increasingly difficult to find in pharmacies suddenly flooded with people bearing prescriptions for a five-day supply to have just in case they experience symptoms of COVID-19.

Nusbaum said she would ask other doctors not to prescribe the drug to the general community where a patient does not already have COVID-19. She said its use as a prophylaxis or preventive drug, has not been proved to be effective.

“If you are prescribing this medication in these capacities, you are potentially making it more difficult to get for those who need it,” she said. “People without COVID-19 should not be stockpiling this in their houses.”

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