Q: I recently read that a combination of the drugs hydroxychloroquine and azithromycin might be effective against COVID-19. I have diabetes and I am at risk for this viral infection. Should I try to get these medications and take them to prevent an infection?
A: Hydroxychloroquine is a medication that is typically used to treat malaria, a parasitic disease disseminated by mosquitos. There is scant data that suggests that hydroxychloroquine or its cousin chloroquine may be able to block the ability of corona viruses to infect cells and replicate, and that they may also be able to damp down the release of inflammation-promoting molecules that are produced by the immune system in response to COVID-19.
These inflammatory molecules when over produced (in a situation called a cytokine storm) can cause severe and dangerous damage to the lungs.
Azithromycin is an antibiotic used to treat bacterial infections and in this case could be effective against co-occurring bacterial infections that often accompany viral infections.
The problem is that any suggested use of these medications is based on very little data from laboratory studies or arises from extremely small studies in infected patients.
At press time for this issue, studies of hydroxychloroquine and hydroxychloroquine/azithromycin are on-going and we will know more soon. Given the potential toxicities of these medications and the lack of data to support their use they should not be used against coronavirus at this point except in clinical trials. There was a recent sad case of a person who died after taking some chloroquine phosphate, which was intended for use in killing parasites in fish, in a misguided attempt to self-medicate.
This case unfortunately underlines that fact that this medication can be very toxic and even fatal and that anyone should only approach its use after sufficient clinical trials have been completed and then only under the supervision of a licensed prescriber.
John R. White is the chair of the Department of Pharmacology at WSU College of Pharmacy and Pharmaceutical Sciences based in Spokane.
