Earlier this week, the Indian Council of Medical Research (ICMR) approved the use of antimalarial drug hydroxychloroquine (HCQ) for high risk individuals as a precaution against the novel coronavirus. Several countries around the world have adopted the use of HCQ in their fight against the coronavirus pandemic. This has, however, led to several stories of people who are attempting to self-medicate using the drug, a concern that many doctors have voiced.
Quinine, a predecessor of HCQ, was discovered from the bark of the Cinchona Tree in the 1600s. By the 1940s, its derivative, chloroquine, was being used widely to treat malaria. However, it was found to have extremely toxic side effects. Scientists later developed HCQ, a further derivative of chloroquine, which was found to be less harmful.
“Some of the most commonly seen side effects include hypersensitivity, retinal problems, and irregular heart rate," explains Bengaluru-based pharmacologist Dr Annapurna. “In some people who have chronically been taking the drug or in those who have any major underlying health issues, it may cause more severe side effects.”
Anyone who experiences side effects is advised to stop the drug at once and consult with their doctor.
Hypersensitivity occurs when someone experiences an allergic reaction to a substance. Many individuals who have been given HCQ are known to develop a severe allergic reaction, which is why it is advised to give the drug under medical supervision. Retinal problems caused by HCQ can cause permanent damage to the vision. Irregular heart rate can be particularly concerning in individuals who already suffer from certain heart conditions such as arrhythmia, in which the heart rate is already not normal.
Given that the side effects from the drug can be severe enough to even be fatal, why is it permitted to be used against COVID-19 in the first place? So far, trials have only shown it to offer some protection against contracting the coronavirus but it does not work on a guaranteed basis.
There is little information available about the novel coronavirus, the causative agent of COVID-19, since it was only identified in December 2019. Scientists were able to decode its structure in February. From this, they were able to look at different drugs which could possibly fight the virus. A few rushed studies later, they were able to determine two drugs which seemed to be effective in controlling the spread of the virus: remdesivir and chloroquine. Hydroxychloroquine is a form of chloroquine which was found to be more effective in “taming” the virus.
According to Dr Gloria Josephine, a pharmacology professor from Chennai, the virus that has broken out is entirely new and thus poses a tough challenge to drug developers around the world who are racing to find an effective treatment against it.
While many hospitals have begun ensuring that their staff members are given this drug, doctors across India have urged that the drug not be sold without a prescription for the fear of the repercussions it may have.
“We have decided to give our doctors and staff the medication, this is especially important for those with maximum exposure (to COVID-19 patients),” says Dr Anirudh Rajkumar, Surgeon and Director of Lifeline Hospitals in Kilpauk, Chennai . He is one of the many doctors who believe that HCQ should only be given to those individuals who are deemed to be at a higher risk of being exposed to and contracting the virus.
Several medical professionals have come out to express their concerns that self-medicating with HCQ could result in more complications than do good.
“Even as an antimalarial drug, it has been selectively given to patients, because of the side effects,” says Dr Annapurna.