Updated: July 21, 2020 2:12:33 am
Much in demand not so long ago in the battle against Covid-19, hydroxychloroquine tablets have piled up in godowns after manufacturers increased production but later found no takers as the early advocacy of its efficiency in treating coronavirus patients gave way to skepticism.
In Maharashtra, Food and Drug Administration (FDA) data shows there is a stock of 48 lakh tablets with manufacturers, government and in the market. India is the largest manufacturer of the anti-malarial drug. “In April and May there was a surge in demand for hydroxychloroquine, so manufacturing was scaled up. A lot of it was exported to USA,” said FDA commissioner A B Unhale.
HCQ is an anti-malarial drug that is also used to treat arthritis and lupus. The drug shot to fame in March when US President Donald Trump declared it as a “game changer” in the battle against Covid-19 and imported stock from India. In India, it was recommended for use by ICMR as a prophylactic for frontline health workers. In the state, government advised it for all health staff and Mumbai police had distributed it to police personnel as prophylaxis. Several private hospital staff also took the drug as preventive medication. The drug was also recommended for treating Covid-19 patients in state’s treatment protocol. Both public and private hospitals followed this protocol and extensively used HCQ.
In April at least 64 local manufacturers in Maharashtra got new licences to manufacture HCQ to cater to the rising demand. The demand continued to soar through April and May. On June 15, the US FDA withdrew the emergency use authorisation of the drug for treating Covid-19 patients saying that “the known and potential benefits of chloroquine and hydroxychloroquine no longer outweigh the known and potential risks for the authorized use.” On June 17, the World Health Organisation announced it was stopping the HCQ arm of the Solidarity trial after finding no reduction in mortality with the use of HCQ. The data was based on the Solidarity trial, UK’s Recovery trial and a Cochrane review of other evidence on HCQ.
The drug was also found to have cardio toxicity in patients with existing heart conditions.
Earlier in May, Maharashtra FDA had recorded a stock of 22 lakh HCQ tablets in market, by July 20 the stock rose to 48 lakh. “The stock has grown because manufacturing increased tremendously but sales dipped,” said J B Mantri, holding charge of joint commissioner (drugs). Of the 48 lakh, 17.21 lakh tablets are with government, 23.36 lakh strips are in market and 7.34 lakh tablets with distributors.
“The choice for using medicines in private hospitals is driven by what western countries do. Hydroxychloroquine is mostly being consumed in government centres and by health workers as prophylaxis now,” said Jagannath Shinde, from All India Organization of Chemists and Druggists (AIOCD).
AIOCD data analysis, based on records from various HCQ manufacturers, shows across India 17.5 lakh HCQ strips (one strip has 15-20 tablets) were sold in February in the domestic market, which rose to 27.4 lakh strips in March. The sales fell in April to 24.7 lakh strips. In May, 26 lakh strips were sold. In June, 24.7 lakh strips were sold across India. In July, AIOCD expects a further dip in sales.
Last year, June sales of HCQ were just 15.7 lakh strips.
In India, the largest manufacturers for HCQ are Ipca Laboratories, Zydus Cadilla, and Torrent Pharmaceuticals, while Cipla and Sun Pharma manufacture smaller quantities. All these manufacturers had scaled up their capacity expecting a continued demand during the pandemic.
An official said, “Earlier we were running 24 hour shifts because the demand was huge, now we have a normal eight hour shift in manufacturing unit. We have huge stock available now. We can supply whenever demand is raised.”
Several private doctors told The Indian Express they are refraining from use of HCQ due to related events of cardio toxicity and erratic heartbeat. Doctors said they used the drug on Covid-19 patients initially but reduced its usage after coming across research that posed serious questions about its use for Covid-19 treatment.
Dr Hemant Deshmukh, dean in KEM hospital, said HCQ is still used in mild to moderate patients in government hospitals after careful scrutiny of medical parameters like ECG test reports and comorbidities. “We have not stopped its use entirely, but definitely reduced it,” he said.
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