The ICMR on Monday recommended the use of hydroxychloroquine for the treatment of the novel coronavirus for two categories of ‘high risk population’. The drug, that has existed for several decades, has been recommended for prophylaxis in case of asymptomatic healthcare workers involved in the care of suspected or confirmed cases of COVID-19 and asymptomatic household contacts of laboratory confirmed cases.
Hydroxychloroquine (not to be confused with anti-malaria drug chloroquine) is an oral medication used in the treatment of autoimmune diseases such as rheumatoid arthritis. The use of the drug gained traction after US President Donald Trump tweeted on March 21 about the use of a cocktail of hydroxychloroquine-azithromycin as a “big game-changer in the history of medicine”.
However, an article in The Lancet Global Health on March 19 had explored its therapeutic and prophylactic properties. “Notably, the drug shows antiviral activity in vitro against coronaviruses, and specifically, SARS-CoV-2 [the virus that causes COVID-2]. Pharmacological modelling based on observed drug concentrations and in vitro drug testing suggest that prophylaxis with hydroxychloroquine at approved doses could prevent SARS-CoV-2 infection and ameliorate viral shedding.”
In the United States, several clinical trials of hydroxychloroquine for prophylaxis or treatment of SARS-CoV-2 infection are planned or will be enrolling soon.
In India, the National Taskforce for COVID-19 set up by ICMR issued guidelines for the use of Hydroxychloroquine, which read: “Hydroxy-chloroquine is found to be effective against coronavirus in laboratory studies and in-vivo studies. Its use in prophylaxis is derived from available evidence of benefit as treatment and supported by pre-clinical data… The following recommendation… is based on these considerations, as well as risk-benefit consideration, under exceptional circumstances that call for the protection of high-risk individuals.”
The two categories, namely, ‘Asymptomatic Healthcare Workers’ and ‘Asymptomatic household contacts’ of laboratory-confirmed cases have been advised to use the medication to contain further spread of the pandemic. The protocol recommended by the National Task force has been approved by the Drug Controller General of India for restricted use in emergency situations.
According to MedlinePlus, the online information service produced by the United States National Library of Medicine, the side effects of hydroxychloroquine include headache, dizziness, loss of appetite, nausea, diarrhea, stomach pain, vomiting, and skin rash. Its overdose can lead to seizures or the patient falling unconscious.
Due to higher in-vitro activity against SARS-CoV-2 and its wider availability in the United States compared with chloroquine, hydroxychloroquine has been administered to hospitalized COVID-19 patients on an uncontrolled basis in multiple countries, including in the United States. One small study suggested that hydroxychloroquine alone or in combination with azithromycin reduced detection of SARS-CoV-2 RNA in upper respiratory tract specimens compared with a non-randomized control group but did not assess clinical benefit.
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