Shortly after the 9/11 terror attack, several people received envelopes contaminated with the dangerous bacteria anthrax. In all, 17 people had nonfatal injuries, and five people died. The popular fluroquinolone antibiotic was found to be possibly effective in the prevention and treatment of anthrax exposure.
This led to a very large increase in prescriptions for Cipro or Ciprofloxacin, written by doctors, dentists, and pretty much anyone who had prescriptive authorization in New York. I was the owner of a community pharmacy at the time, and my wholesalers could not keep up with the demand to supply the community, chain and hospital pharmacies. It led to conflicts as I questioned a pediatrician why he was prescribing 60 tablets of Cipro for himself, wife and two children, 240 tablets in all. I told him I would not be able to supply my patients who needed it immediately for respiratory or urinary tract infections. He did not find my protestations reasonable, but I offered to fill only one. He agreed. A few months later, he called and asked whether he could return it and get a refund because he didn’t need it anymore. The anthrax scare was over. (I did not take it back. New York State law prohibits return of prescription medication.)
Flash to 2020, and now Gov. Andrew M. Cuomo has limited the prescriptions of hydroxychloroquine and chloroquine to coronavirus patients in state-approved clinical trials and for uses approved by the Food and Drug Administration.
A few small studies have suggested there might be evidence that hydroxychloroquine and chlorquine, two older antimalarial medications, may help patients with COVID-19. Azithromycin also has been tested in conjunction with hydroxychloroquine. Unfortunately, these studies did not follow the clinical guidelines in terms of the number of patients, methodology, data collection, and outcomes. The World Health Organization and the National Institutes of Health are doing trials on these medications, and others, such as remdesvir. These regimens might help in the fight against COVID-19, but it is not known yet. We will certainly have better and hopefully valid data to assess the treatments. The question then arises, why not just try using these medications for prevention or treatment? What’s the harm?
First, tens of thousands of patients use hydroxychloroquine to treat rheumatoid arthritis and systemic lupus erythematosus. These patients require it; it is not an optional treatment. And now it is unavailable in many pharmacies on Long Island. A former student of mine said that 10 of his patients are waiting to get their prescription filled because it is out of stock. Prescribers are writing it for patients, family and friends, denying patients who really need it now, possibly ending up in the hospital.
There is also a danger in taking these medications. Hydroxychloroquine is known to cause damage to the retina, muscle problems and prolonged QT interval (a change to the heart rhythm), which could be fatal. Based on false information, a couple in Arizona took chloroquine that was intended for aquarium use to prevent getting COVID-19. The husband died, and the wife is in critical condition.
Let’s not harm ourselves or our friends and neighbors. Trying unproven remedies rarely leads to positive results. Listen to Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, the Centers for Disease Control and Prevention, and your local departments of health for accurate information.
We must learn from past mistakes so that essential medication remains available to those who truly need it.
Peter Goldstein, a pharmacist, is an adjunct associate professor in the pharmacy program at the Brooklyn campus of Long Island University.