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Africa News Thu, 26 Mar 2020

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Pharmacies prohibited from dispensing chloroquine, hydroxychloroquine

Anti Malaria Pill Chloroquine.png Nigeria is reporting two poisonings from the drug chloroquine

The Pharmacy and Poisons Board has prohibited all pharmacies and chemists in the country from dispensing chloroquine and hydroxychloroquine to clients without a valid prescription from a medical doctor.

In a statement Wednesday, the board warned that irrational use of these hydroxychloroquine may lead to irreversible blindness which is detrimental to the health of the general public.

However, the board noted that there are real patients who are in need and depend on these medications every day to improve their quality of life in the management of rheumatoid arthritis, systemic lupus erythematosus and porphyria cutanea tarda.

Following the news that the United States of America is using chloroquine and hydroxychloroquine to treat SARS-COV-2, there has been a rush by many to acquire these medicines from pharmacies to stock them.

The board called on Kenyans to note that clinical trials utilizing the two medicines are currently ongoing and no robust clinical data substantiating their use for prophylaxis and curative purposes is available, hence caution has to be applied when using them.

According to Wikipedia, Chloroquine is a medication primarily used to prevent and treat malaria in areas where malaria remains sensitive to its effects. Certain types of malaria, resistant strains, and complicated cases typically require different or additional medication.

It is also occasionally used for amebiasis that is occurring outside the intestines, rheumatoid arthritis, and lupus erythematosus. While it has not been formally studied in pregnancy, it appears safe and s taken by mouth.

Common side effects include muscle problems, loss of appetite, diarrhea, and skin rash. Serious side effects include problems with vision, muscle damage, seizures, and low blood cell levels.

Chloroquine is a member of the drug class 4-aminoquinoline. As an antimalarial, it works against the asexual form of the malaria parasite in the stage of its life cycle within the red blood cell. How it works in rheumatoid arthritis and lupus erythematosus is unclear.

Chloroquine was discovered in 1934 by Hans Andersag. It is on the World Health Organization’s List of Essential Medicines, the safest and most effective medicines needed in a health system. It is available as a generic medication.

Overdose

Chloroquine is very dangerous in overdose. It is rapidly absorbed from the gut. In 1961, a published compilation of case reports contained accounts of three children who took overdoses and died within 2.5 hours of taking the drug. While the amount of the overdose was not stated, the therapeutic index for chloroquine is known to be small. One of the children died after taking 0.75 or 1 gram, or twice a single therapeutic amount for children. Symptoms of overdose include headache, drowsiness, visual disturbances, nausea and vomiting, cardiovascular collapse, seizures, and sudden respiratory and cardiac arrest.

An analog of chloroquine – hydroxychloroquine – has a long half-life (32–56 days) in blood and a large volume of distribution (580–815 L/kg). The therapeutic, toxic and lethal ranges are usually considered to be 0.03 to 15 mg/l, 3.0 to 26 mg/l and 20 to 104 mg/l, respectively. However, nontoxic cases have been reported up to 39 mg/l, suggesting individual tolerance to this agent may be more variable than previously recognized.

COVID-19

In late January this year, Chinese medical researchers stated that exploratory research into chloroquine seemed to have “fairly good inhibitory effects” on the SARS-CoV-2 virus and requests to start clinical testing were submitted.

Chloroquine has been recommended by Chinese, South Korean and Italian health authorities for the experimental treatment of COVID-19. These agencies noted contraindications for people with heart disease or diabetes. Both chloroquine and hydroxychloroquine were shown to inhibit SARS-CoV-2 in vitro, but a further study concluded that hydroxychloroquine was more potent than chloroquine, with a more tolerable safety profile. Preliminary results from a trial suggested that chloroquine is effective and safe in COVID-19 pneumonia, “improving lung imaging findings, promoting a virus-negative conversion, and shortening the disease course.”

However, there have been fatalities reported in different parts of the world due to misuse of a chloroquine product used to control fish parasites.

Hydroxychloroquine (HCQ), sold under the brand name Plaquenil among others, is a medication used for the prevention and treatment of certain types of malaria. specifically it is used for chloroquine-sensitive malaria. Other uses include treatment of rheumatoid arthritis, lupus, and porphyria cutanea tarda. It is taken by mouth.

Common side effects include vomiting, headache, changes in vision and muscle weakness.Severe side effects may include allergic reactions. Although all risk cannot be excluded, it remains a treatment for rheumatic disease during pregnancy.

Hydroxychloroquine is in the antimalarial and 4-aminoquinoline families of medication. It was approved for medical use in the United States in 1955 and is on the World Health Organization’s List of Essential Medicines, the safest and most effective medicines needed in a health system.

Overdose

Due to rapid absorption, symptoms of overdose can occur within a half an hour after ingestion. Overdose symptoms include convulsions, drowsiness, headache, heart problems or heart failure, difficulty breathing and vision problems.

Hydroxychloroquine overdoses are rarely reported, with seven previous cases found in the English medical literature.

In one such case, a 16-year-old girl who had ingested a handful of hydroxychloroquine 200mg presented with tachycardia (heart rate 110 beats/min), hypotension (systolic blood pressure 63 mm Hg), central nervous system depression, conduction defects (a prolonged QRS complex, about 0.14 sec, which is normally less than 0.1 sec[18]), and hypokalemia (K = 2.1 meq/L).

Treatment consisted of fluid boluses and dopamine, oxygen, and potassium supplementation. The presence of hydroxychloroquine was confirmed through toxicologic tests. The patient’s hypotension resolved within 4.5 hours, serum potassium stabilized in 24 hours, and tachycardia gradually decreased over three days.

COVID-19

On 13 February 2020, hydroxychloroquine and chloroquine were recommended by a South Korean task force for the experimental treatment of coronavirus disease 2019 (COVID-19). In vitro studies in cell cultures demonstrated that hydroxychloroquine was more potent than chloroquine against SARS-CoV-2.

On 17 March 2020, the AIFA Scientific Technical Commission of the Italian Medicines Agency expressed a favorable opinion on including the off-label use of chloroquine and hydroxychloroquine for the treatment of COVID-19.

A randomized controlled trial by Chinese researchers showed no positive effect with hydroxychloroquine at a dosage of 400 mg per day. A study from Marseille, France, showed a reduction in viral load at a dosage of 600 mg a day, however, the study was criticized for its methodology. The people were not randomized and three from the treatment group that was transferred to an intensive care unit and one who died were excluded from the analysis.

Source: kbc.co.ke

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