It all started because of cinchona bark. Jesuit missionaries in South America stumbled upon the bark of the quina-quina (cinchona) tree in the 1600s. Whether they learned of its healing properties from the indigenous people or discovered it in some serendipitous fashion is lost in the mists of time. An extract, quinine, was developed in 1820 and became a popular treatment for malaria. The U.S. Army started using a derivative, chloroquine, in 1943. Hydroxychloroquine (HCQ) was approved by the FDA in 1955 under the brand name Plaquenil. It is used to treat malaria, lupus erythematosus and rheumatoid arthritis. HCQ probably would have been forgotten had it not been for COVID-19. Some doctors claimed that it was a breakthrough against SARS-CoV-2. Discussions of hydroxychloroquine harm were dismissed.
Was Hydroxychloroquine Helpful Against COVID?
Preliminary studies produced mixed results. Some suggested benefit. Others were discouraging. One of the largest studies revealed hydroxychloroquine harm and no benefit The Lancet (May 22, 2020). This study was retracted however.
HCQ soon became politicized. There were advocates who believed the drug was the answer to COVID. There were detractors who insisted the drug was ineffective and dangerous. As usual in such circumstances, the answer was somewhere in between.
A more recent meta-analysis of randomized trials published in the Journal of Thoracic Disease (May 31, 2024) concluded:
“In this meta-analysis, 9 published RCTs [randomized controlled trials] including 7,825 participants who were SARS-CoV-2 negative were enrolled. Combining the data from all studies, we found a statistically significant difference in the reduction of SARS-CoV-2 infections between the HCQ arm and the control arm (RR =0.76, P<0.0001).”
In other words, hydroxychloroquine did seem to reduce the risk of catching COVID. It also reduced the likelihood of being hospitalized because of the SARS-CoV-2 virus. But, and this was a very big but, there was significant risk of hydroxychloroquine harm.
The 2024 Meta-Analysis Also Reported Hydroxychloroquine Harm:
The latest study published in the Journal of Thoracic Disease (May 31, 2024) reported benefit against COVID but also described worrisome adverse drug reactions.
HCQ Side Effects:
The FDA warns of heart damage and potentially life-threatening irregular heart rhythms:
- “Fatal or life-threatening cardiomyopathy and ventricular arrhythmias were reported.
- “Irreversible retinal damage is related to cumulative dosage and treatment duration.
- “Serious Skin Reactions: Stevens Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis have been reported.”
Dermatological problems were recently brought home to us by a reader:
Q. I was prescribed hydroxychloroquine to deal with the pain of rheumatoid arthritis. The immediate response was very positive. The pain was under control.
However, after taking it for three months I began to have red spots and skin problems on my hands, arms and legs. My dermatologist diagnosed a reaction to the medicine and instructed me to stop taking it and apply a steroid cream to the affected areas.
Was hydroxychloroquine tested for its long-term effects? Is this reaction common? It seems to be diminishing but I wonder if it will ever totally disappear.
A. Skin reactions to hydroxychloroquine are well recognized and can be serious. Some people develop Stevens-Johnson syndrome, while others may experience toxic epidermal necrolysis. Both of these conditions may be life threatening. Such reactions can be delayed several weeks or even months.
We’re glad you are getting better, but you may want to check in with an allergist or immunologist. Stay out of the sun to avoid making the problem worse.
Other Hydroxychloroquine Harm:
- Digestive disorders (stomachache, nausea, vomiting, diarrhea)
- Visual disturbances
- Negative blood effects
- Breathing problems
- Muscle pain
- Nerve pain
- Long QT interval (a serious heart arrhythmia)
- Psychological problems, suicidal ideation
- Low blood sugar
People’s Pharmacy Perspective:
We were pleased to learn that hydroxychloroquine has some antiviral activity after all. People who were anxious to dismiss this old medication should take a second look. On the other hand, hydroxychloroquine harm is real. The drug has some serious side effects.
Monitoring the Electrocardiogram:
Anyone being considered for HCQ treatment should get an electrocardiogram (ECG) before they are given HCQ or AZM [azithromycin]. That’s because both drugs can prolong the QT interval on an ECG. If both drugs are taken together that is likely to increase the risk for dangerous heart rhythm abnormalities. The data from The Lancet study reinforce this concern.
You can find out what the QT interval is and why it is so important at this link. You will get a crash course on ECG interpretation and learn why hydroxychloroquine and azithromycin pose a significant threat to the heart.
Reports of Hydroxychloroquine Harm Riled Readers:
We know that many of our readers were upset about the research that showed small benefits and significant side effects. They did not want to hear about hydroxychloroquine harm.
Here are just a few comments from readers:
Dawn does not believe patients need to be hospitalized or participate in a clinical trial to get hydroxychloroquine:
“Physicians could be allowed to more freely prescribe the medication to patients in the outpatient setting. The number of physicians who have attempted to speak out via social media or mainstream media have been silenced by so-called ‘fact checkers’ and, in some instances, even by their professional organizations.
“Data could be collected from physicians regarding the efficacy of Hydroxychloroquine in combating COVID-19, but ONLY IF physicians are allowed to prescribe the medication in the outpatient setting and earlier in the disease process. There are ways and means to coordinate such a study if the physicians were allowed to do it.”
Don says it’s all about the money:
“There’s no profit to be made from wide distribution of this low cost and not patentable drug. This is why testing is rigged to show that it is ineffective: 1. Test primarily on people who are already very ill. 2. When testing on those who are not yet seriously ill, do not combine with zinc and azithromycin, which is the clinical treatment found to be most effective. 3. Use the media to discredit it, and censor dissenting voices.”
“The testimony of dozens, if not hundreds of doctors and thousands of patients who have been helped with this drug count for nothing.”
Linda says HCQ only works with azithromycin and zinc:
“I have seen many doctors say they’ve had major success treating patients with hydroxychloriquine together with azithromycin and zinc. The drugs have to be administered early and before patients need hospitalization. It was already too late for these patients.”
Faye says we’re “hacks”:
“You are just another hack going against a drug that has been used for years and is cheap. I read your articles for advice, but I don’t know If I can trust anything you write on any drug now.”
Mary says that side effects are minimal:
“If ever I faced this virus, I would most gratefully welcome the opportunity for this drug with azithromycin. My husband has had two friends through his line of work in different parts of the country who took this drug with azithromycin and recovered beautifully. I would hope that those afflicted with this virus would have the opportunity to try these and other drugs rather than wait until it’s too late, especially when the side effects are minimal.”
James is questioning our objectivity:
“There are so many real-life examples of HCQ working that you are causing many of your readers to start wondering about the accuracy and legitimacy of other articles you have written. This is the first time I am seriously considering blocking your newsletter. It is really sad to see what is happening to the media these days. Money and politics seem to control things now.”
Final Words:
We take no satisfaction in reporting on hydroxychloroquine harm. We were glad to see that the most recent meta-analysis revealed that HCQ has antiviral activity and helped some patients avoid COVID and remain out of the hospital. Whether the benefits outweigh the risks, though, has not been fully resolved.
Feel free to share your thoughts about HCQ in the comment section below.
