(Updated 4/7/20 to include some additional support for Hydroxychloroquine, including the potentially beneficial use of zinc.)
Our team at Apothecary Compounding Pharmacy at Alive and Well is here to support our community and the brave providers that are working tirelessly to care for their patients at this critical time. In consideration of this current environment, we want to deliver our very best to help.
There are a number of questions about two drugs being considered as potential options for treating COVID-19: chloroquine and hydroxychloroquine. We feel that our background in pharmacology, as well as our engagement with the medical community on the front lines, provides us with the opportunity to provide some answers on this topic.
First and foremost: please only consider using these medications to treat COVID-19 if your doctor recommends that you do so.
What are chloroquine and hydroxychloroquine?
Chloroquine, and its derivative hydroxychloroquine, are part of a class of prescription drugs known as disease-modifying antirheumatic drugs (DMARDs). They act by altering the underlying disease rather than treating symptoms. Chloroquine and hydroxychloroquine are conventional DMARDs that act as anti-inflammatory immunosuppresives (they interact with the immune system to reduce inflammation).
These drugs are approved by the FDA to prevent or treat malaria by killing the parasites that cause the disease. Due to its potential anti-inflammatory properties, hydroxychloroquine is also approved to treat lupus and rheumatoid arthritis. They are both reasonably priced and have a long history of effectiveness for the approved treatments. Common side-effects include headache, dizziness, diarrhea, stomach cramps and vomiting.
Why are they being considered for COVID-19?
The CDC has suggested that both drugs have demonstrated efficacy in treating severe acute respiratory syndrome coronaviruses based on limited data.(1) A recent study in China demonstrated that chloroquine had clinical and virologic benefits for treatment of COVID-19 patients versus a comparison group. (2) In vitro studies indicates that chloroquine may prevent SARS-CoV-2 replication as well as reduce the exacerbation of pneumonia and duration of symptoms ( 3, 6)
Additionally, the physicians of the COVID-19 Central Clinical Task Force of South Korea have recommended a treatment protocol the includes either chloroquine, or Kaletra (lopinavir / ritonavir combination). Notably, South Korea has shown some of the lowest death rates among COVID-19 patients in the world. (7)
Are these drugs approved by the FDA for treatment of COVID-19?
Chloroquine and hydroxychloroquine are FDA approved to treat malaria, as well as lupus and rheumatoid arthritis, but not for treatment of COVID-19. However, due to the emergent nature of the current pandemic, the World Health Organization recently launched a global megatrial of the most promising coronavirus treatments, including chloroquine and hydroxychloroquine (4). Given the potential benefit of chloroquine and hydroxychloroquine, the FDA is NOT prohibiting doctors from prescribing nor pharmacies from dispensing these drugs for the purpose of COVID treatment. (5)
What about the combined treatment of azythromycin and chloroquine?
In a recent study, patients with COVID-19 experienced enhanced recoveries when given the combined treatment of hydroxychloroquine and the antibiotic azithromycin. (6) More data is necessary for the medical community to conclude that this combination is indeed most beneficial, supporting the need for the WHO megatrials.
Is zinc effective as a combination with hydroxychloriquine?
It has been postulated that zinc improves the efficacy of hydroxychloroquine when used as part of a treatment protocol. As explained in a widely viewed video by Medmastery, zinc has been shown to slow or stop the replication of the virus in cell culture. Hydroxychloroquine appears to make the cell wall permeable, allowing zinc to enter the host cell to disrupt the coronavirus replication.
Doctors around the country are prescribing a hydroxychloroquine / zinc protocol. Dr. Zelenko in New York and Dr. Cardillo in Los Angeles are two that have provided public feedback on results from their practice. While these protocols have not been scientifically tested in clinical trials, the results are promising and support additional research. (8,9)
How can I get hydroxychloroquine, chloroquine or azythromycin if I get sick?
These drugs must be prescribed by a licensed physician and reviewed by a licensed pharmacist. We only recommend administering these medications that are obtained through a pharmacy or properly FDA licensed facility. While chloroquine and hydroxychloroquine powders are available for purchase online, they are reagent grade and dangerous for human consumption.
Can I get these drugs at any pharmacy?
Chloroquine and hydroxychloroquine are now in high demand due to the recent studies as a potential treatment for COVID-19. As such, many pharmacies have little to no supply on hand to dispense. Our pharmacy currently has hydroxychloroquine tablets in stock. In addition, our compounding lab has the ability to manufacture additional capsules as needed, increasing the total supply necessary to meet the growing demand. In order to ensure adequate supplies of the drug for those with an active COVID-19 infection we are following the Texas State Board of Pharmacy's ruling that the medication only be dispensed to those with positive COVID-19 diagnosis or other evidence for the necessity of the drug. Prophylactic dispensing is not allowed per this rule.
What else can I take if I get sick?
We have an array of compounded products that may help with many of the respiratory symptoms experienced by those infected by COVID-19. These products include both oral and nebulized medications and combinations. Please talk to your doctor if you are feeling symptoms and would like to explore options for medication.
What else should I know?
This is an uncertain time that is evolving every day. We are here to help. For more information on COVID-19, please refer to our articles on the topic. Feel free to contact us with additional questions at 512.351.9139 or message us here. We deliver prescriptions and supplements for free throughout the state of Texas.