Hydroxychloroquine; A Reason for Cautious Optimism

Dr. Donny Reeves

Fear related to the current pandemic crisis of coronavirus has led people to try many methods of protection or treatment. While the effectiveness of many of these methods may be called into question, few have as many dire consequences as experimenting with unproven drugs.

One such drug that has been in the spotlight lately is Hydroxychloroquine. I certainly do not want to discourage patients from accepting treatment prescribed by their physicians, but without the calculated decision of a medical doctor with the knowledge of a patient’s existing conditions and prescriptions, the effects of HCQ can be life threatening.

HCQ, commonly referred to as an anti-malaria drug, was first approved for medical use in the United States in 1955 and is on the World Health Organizations list of essential drugs. Though most strains of malaria have grown immune to HCQ, the drug is still widely used today in the United States for treatment of autoimmune disorders like rheumatoid arthritis and lupus. With very few manufacturers of HCQ, the first severe consequence of the misuse of this drug is a dwindling supply and inhibited access by those dependent upon it for terminal preexisting conditions not related to COVID-19.

Because HCQ is rapidly absorbed, symptoms of an overdose can occur in as little as 30 minutes and include convulsions, headache, heart failure, difficulty breathing, vision loss and death. As with any prescribed medication, HCQ should not be taken without orders from a qualified physician with the knowledge of the patient’s medical history. There have already been several reported deaths and near fatal illnesses across the country as a result of self-medicating. The treatment should not be worse than the disease, and hospitalizations as a result of self-induced drug poisoning pull necessary healthcare personnel away from treating infected patients.

Finally, it should be noted that large doses of HCQ, as may be necessary for treatment of COVID-19, and daily dosages for five years or more as in the treatment of rheumatoid arthritis or lupus can cause irreversible vision loss. Hydroxychloroquine retinopathy also known as bulls-eye maculopathy because of the bulls-eye ring it can leave on the retina surrounding the macula, is caused by retina toxicity from cumulative dosages of HCQ of up to 1000 grams, but vision can be compromised in much lower cumulative dosages. That is why patients prescribed a routine of HCQ are recommended to have a baseline ocular exam in the first year on the drug and regular annual ocular examinations to monitor any changes in vision before they are apparent to the patient.

The use of HCQ for treatment of COVID-19 should be considered with cautious optimism and only under a medical doctor’s supervision when all risks have been communicated to the patient. HCQ may or may not be a suitable treatment for COVID-19, but it is most definitely a necessary medication for many suffering from autoimmune disorders. When used improperly, HCQ can severely affect one’s lifestyle and even result in death.

For more information on HCQ, see the drug fact sheets at the U.S. Food and Drug Administration website, https://search.usa.gov/search?query=hydroxychloroquine&affiliate=fda1

Donny Reeves, MD is a AAO board certified ophthalmologist with a vast amount of experience and served as a doctor in the United States Army.

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