Hydroxychloroquine and COVID-19

With Coronavirus (COVID-19) streaming through the airways, our televisions and seemingly every mainstream news service, we thought it was prudent to update you on recent advancements in prevention and treatment of the viral disease. We all need to collectively do our part to minimize risk by performing social distancing and other precautionary measures. However, this is not always feasible for everyone, particularly our first line responders. We want to provide information on viable options to combat this virus. 

Hydroxychloroquine is an aminoquinoline commonly used for lupus, malaria and rheumatoid arthritis. This older product approved in 1955 is not alone in being repurposed for an off-label use but I cannot think of a better time than now with this novel strain of coronavirus. Researchers have found Hydroxychloroquine to be effective towards treating Severe Acute Respiratory Coronavirus (COVID-19) infections. The mechanism has not been fully discovered; however, the thought of its action is through affecting the cell membrane surface pH to hinder viral cell fusion to host cell membrane cells. Previous studies have found it can inhibit nucleic acid replication, virus assembly, virus release and other processes to affect the virus. 

Chloroquine is in the same drug class as Hydroxychloroquine but in limited studies Hydroxychloroquine has been shown to be more effective with a better clinical safety profile. Dosing of Hydroxychloroquine with a loading dose of 400mg twice daily at day 1 then maintain 200mg twice daily for 4 days. Improved outcomes have come in limited studies incorporating Azithromycin, Z-pak, in conjunction to Hydroxychloroquine. Azithromycin dosing is a loading dose of 500mg at day 1 and to continue 250mg per day for 4 subsequent days. Limited studies have shown more rapid eradication of virus compared to Hydroxychloroquine alone but make sense toward Azithromycin’s effect against upper respiratory tract infections like pneumonia, which is a common factor associated with COVID-19. We have formulas to compound Hydroxychloroquine into pediatric oral suspension with dosing guidance is children less than 18 being weight based. It is thought that pediatric infections are not as common or severe, but I would not rule anything out. Pediatric dosing starts with a loading dose of 10mg/kg on day 1 followed by 3mg/kg three times daily. We will continue to update the website as we can. We are aware that dissemination of information is vital during this time.

It is important to note that both Hydroxychloroquine and Azithromycin are both associated with QT prolongation. Albeit therapy for both medications is short term, caution should be advised when considering these therapies for patients with certain medical conditions because higher risk for arrhythmias. 

Yao, X., Ye, F.,  Zhang, M., Cui, C., Huang, B., Niu, P., Liu, X., Zhao, L., Dong, E., et al. (2020). In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Clinical Infectious Diseases, 237, https://doi.org/10.1093/cid/ciaa237

Gautret, P. Lagier, J., Parola, P., Hoang, V.T., Meddeb, L., et al. (2020) Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents– In Press 17 March 2020- doi:10.1016/j.ijantimicag.2020.105949