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Hydroxychloroquine Reviews: Use of Hydroxychloroquine (HCQ) As Prophylaxis for COVID 19
The National Taskforce for COVID -19 constituted by the Indian Council of Medical Research (ICMR) recommends the use of hydroxychloroquine (HCQ) for prophylaxis of COVID -19 infection for a high-risk population.
The advisory provides for placing the following high-risk population under chemoprophylaxis with hydroxylchloroquine (HCQ)
• Asymptomatic Healthcare Workers involved in the care of confirmed cases of COVID-19
• Asymptomatic household contacts of laboratory-confirmed cases.
The protocol recommended by the National Task Force has been approved by the Drug Controller General of India for restricted use in an emergency situation
The Important Points to be remembered during the HCQ Prophylaxis are:
1. The placing of healthcare workers under chemoprophylaxis should not instill a sense of false security. They should follow all prescribed public health measures such as frequent hand washing, respiratory etiquettes, keeping social distancing of one meter and use of PPE 2. They should self-monitor their health and report to health authorities immediately in the event of them becoming symptomatic
3. The high-risk contacts of a positive case placed under chemoprophylaxis should remain in home quarantine while on prophylactic therapy
4. As recommended by the said Task Force, the drug should only be given on the prescription of a medical practitioner. The contraindications mentioned in the recommendations should strictly be followed
5. Apart from the symptoms of COVID-19(fever, cough, breathing difficulty), if the person on chemoprophylaxis develops any other symptoms, he should immediately seek treatment of the medical practitioner who has prescribed the chemoprophylaxis.
NB:- It is reiterated that the intake of the above medicine should not instill a sense of false security
Recommendation for empiric use of hydroxyl-chloroquine for prophylaxis of COVID-19 infection
Eligible Individual:
• Asymptomatic Healthcare Workers involved in the care of confirmed cases of COVID-19
• Asymptomatic household contacts of laboratory-confirmed cases.
Dose:
• Asymptomatic healthcare workers involved in the care of suspected or confirmed cases of COVID-19:
400 mg twice a day on Day 1, followed by 400 mg once weekly for the next 7 weeks; to be taken with meals
• Asymptomatic household contacts of laboratory-confirmed cases:
400 mg twice a day on Day 1, followed by 400 mg once weekly for the next 3 weeks; to be taken with meals
Hydroxychloroquine Warning:
• The drug is not recommended for prophylaxis in children under 15 years of age
• The drug is contraindicated in persons with a known case of retinopathy, known hypersensitivity to hydroxychloroquine, 4-aminoquinoline compounds
Hydroxychloroquine Reviews: Key Considerations:
• The drug has to be given only on the prescription of a registered medical practitioner
• Advised to consult with a physician for any adverse event or potential drug interactions before initiation of medication
• The prophylactic use of hydroxychloroquine to be coupled with the pharmacovigilance for adverse drug reactions through self-reporting using pharmacovigilance program of India helpline/app
• If anyone becomes symptomatic while on prophylaxis he/she should immediately contact the health facility, get tested as per national guidelines and follow the standard treatment protocol
• All asymptomatic contacts of laboratory-confirmed cases should remain in home quarantine as per national guidelines, even if they are on prophylactic therapy
• Simultaneously, proof of concept and pharmacokinetics studies to be taken up expeditiously. Findings from these studies and other new evidence will guide any change in the recommendation.
Hydroxychloroquine Reviews
The hydroxychloroquine sulfate is widely available as in the trade name of Plaquenil.
The hydroxychloroquine sulfate belongs to 4-aminoquinolone compound
The therapeutic class of hydroxychloroquine sulfates are antiprotozoal, antirheumatic, lupus Erythematosus suppressant.
The pregnancy risk category is C category that means risk to the fetus can’t be ruled out (Inadequate human studies)
Indications for Hydroxychloroquine Sulfate
To prevent malaria
To treat chronic discoid and systemic lupus Erythematosus
To treat acute or chronic rheumatoid arthritis
To prophylaxis and treatment of COVID-19 (under research studies and trials)
Hydroxychloroquine Reviews – Dosages
To Prophylaxis against COVID – 19
400 mg twice a day on Day 1, followed by 400 mg once weekly for the next 7 weeks; to be taken with meals
To prevent Malaria
Tablets
Adult:
400 mg the same day of each week starting 2 week before entering endemic area and continuing until departure from endemic area
Infants and Children:
5mg/Kg the same day of each week, starting 2 weeks before entering endemic areas and continuing until departure from the endemic area.
To treat acute attacks of malaria caused by Plasmodium Vivax, P. malariae, P. Ovale, and susceptible strains of P. Falciparum
Tablets
Adult:
Initial 800 mg, followed by 400 mg in 6 to 8 hour and 400 mg on next 2 consecutive days
Infants and Children:
Initial 10 mg base/Kg (Maximum, 620 mg base) followed by 5mg base/kg 6 hours after the first dose, 5mg base/Kg 18hour after the second dose, and 5 mg base/kg 24 hours after the third dose
To treat chronic discoid and systemic lupus Erythematosus
Tablets
Adults:
Initial 400 mg once or twice daily for several weeks or months. Maintenance 200 to 400 mg daily
To treat acute or chronic rheumatic arthritis
Tablets
Adults:
Initial 400 to 600 mg daily for 4 to 12 weeks. Maintainance dose of 200 mg to 400 mg daily.
Hydroxychloroquine Sulfate Mechanism of Action
It may mildly suppress the immune system, inhibiting the production of rheumatoid factor and acute phase reactants.
Hydroxychloroquine also accumulates in WBCs, stabilizing enzymes such as collagenase and proteases that cause cartilage breakdown. These actions may decrease symptoms of rheumatoid arthritis and lupus Erythematosus.
Hydroxychloroquine also binds to and alters DNA of the malaria parasite to prevent it from reproducing. It also may increase the pH of acid vesicles, which interferes with vesicle function and may inhibit parasitic phospholipid metabolism in erythrocytes, thereby halting plasmodial activity
Inhibits infection of cells by SARS-CoV-2 in vitro but there are no adequate studies available on it
Hydroxychloroquine interactions
Aurothioglucose: Increased risk of blood dyscrasias
Digoxin: Increased digoxin concentrations
Side effects of Hydroxychloroquine
The drug can cause heart rhythm problems, severely low blood pressure, and muscle or nerve damage. Taking it outside of a scientific experiment adds the risk of not having tracking in place to watch for any of these side effects or problems and quickly address them if they do occur.
Central Nervous System:
Abnormal nerve conduction, ataxia, dizziness, emotional lability, headache, irritability, lassitude, nervousness, neuromuscular sensory abnormalities, nightmares, psychosis, seizures, vertigo
Cardiovascular system
Cardiomyopathy (Prolonged high doses)
Eye, Ear, Nose and Throat
Abnormal pigmentation (bullseye appearance) or colored vision, blurred vision, central scotoma with decreased visual acuity, corneal deposits, decreased corneal sensitivity, diplopia, irreversible retinal damage, halo vision, lassitude, macular edema or atrophy, nerve-related hearing loss, nystagmus, photophobia, tinnitus
Endocrine system:
Hypoglycaemia
Gastrointestinal System:
Abdominal cramps, anorexia, diarrhea, elevated liver function test results, fulminant hepatic failure, nausea, vomiting
Hematology System:
Agranulocytosis, Aplastic anemia, hemolysis, hemolysis (in patients with G6PD), leukopenia, thrombocytopenia
Atrophy of proximal skeletal muscle groups, depressed tendon reflexes, muscle weakness
Bronchospasm
Skin:
Acute generalized exanthematous pustulosis, alopecia, altered mucosal and skin pigmentation, bleaching or hair, dermatitis, pruritis, psoriasis exacerbation
Hydroxychloroquine Reviews: Nursing Considerations
- Use hydroxychloroquine cautiously in patients with G6PD deficiency, patients with hepatic disease or alcoholism, and patients taking hepatotoxic drugs
- Monitor children closely for adverse reactions because they are especially sensitive to 4-aminoquinoline compounds
- Observe patients with psoriasis closely because hydroxychloroquine may lead to severe psoriasis attack. Also, monitor patients with porphyria closely because hydroxychloroquine in patients with porphyria is closely monitored because hydroxychloroquine may worsen it.
- During prolonged therapy, obtain periodic blood cell counts, as ordered, to detect adverse hematologic effects. Expect to stop the drug if severe adverse effects occur.
- Monitor patient’s vision when giving hydroxychloroquine for lupus Erythematosus or rheumatoid arthritis because irreversible retinal damage may occur in some patients during the long-term or high-dose therapy.
- Monitor patient on long-term therapy for muscle weakness and abnormal knee and ankle reflexes
- Expect drug to be stopped if the patient with rheumatoid arthritis shows no improvement
Hydroxychloroquine Reviews: Patient Teaching
- Instruct patient to take the drug with meals or milk to minimize stomach upset
- Tell patient to take hydroxychloroquine exactly as prescribed because taking too much may cause serious adverse reactions and taking too little or skipping doses decreases the effectiveness
- Caution patient to notify takes the drug for rheumatoid arthritis or lupus Erythematosus about possible visual reactions and the need for periodic eye examinations.
- Caution the patient to notify the prescriber about troublesome adverse reactions. Hydroxychloroquine dosage may need to be adjusted or the drug stopped