What You Should Know About COVID-19 “Cocktails” Like Hydroxychloroquine and Azithromycin

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Our everyday consciousness is inundated by COVID-19 true news or fake news, cautious or hysterical warnings, relevant and irrelevant advisories, and even scams that are emerging to sell remedies. The fight against the Coronavirus has been on many levels, including things like covering every opening our body has, social distancing, and sheltering in place.

Meanwhile, in the background, there are hundreds of legitimate trials for a treatment, cure, and/or vaccine. One of the most promising is remdesivir, used previously for treating Ebolavirus patients. It works by using the very nature of the virus against it, that is, by inserting itself into the virus’ RNA, which causes its premature death.

How can you get your hands on remdesivir?

You can’t. Not easily, anyway. But you should rest assured the remdesivir out there is in the right hands—those of the researchers who are literally racing to qualify or disqualify it for legitimate use. In the meantime, it is tempting to consider drugs out there already that have been mentioned as possibilities.

What’s out there now?

In many press conferences, President Trump touted the drugs hydroxychloroquine (Plaquenil) and azithromycin (the common antibiotic, Z-Pak). While these, too, are being hurriedly studied, the fact that these are easily available may cross your mind. In fact, you probably know many people who take one of them. But you should know casually sharing someone’s stash of hydroxychloroquine or azithromycin is not very rational.

President Trump said, “What’s the harm?” So…what’s the harm?

Perhaps you’ve watched those “Ask-your-doctor-if-such-and-such-is-right-for-you” ads on TV. You’ll notice that the longest parts of these commercials consist of listing all of the things that could possibly happen to you, from stomach-aches to premature death. The government, of course, insists these facts be included, as ANY drug is given on a risk-vs-benefit basis. And that’s where your answer comes from.

What’s the harm? None, if none of those things happen; but unacceptable harm if you’re one of those to whom they do!

Is our President wrong about this COVID cocktail?

Politics aside, you have to assume he meant anyone who was dying from COVID-19 has nothing to lose. I suppose there’s some sense in that, especially if you’re the one dying. But the point here is this: there’s not much risk to someone who’s dying, but there may very well be to someone who’s not.

What about this hydroxychloroquine?

This is a drug used for malaria, but it is also useful in autoimmune diseases like rheumatoid arthritis, Lupus, and inflammatory bowel disease. According to the FDA, CDC, and the NIH, however, it has “yet to demonstrate safety and efficacy in humans diagnosed with or exposed to COVID-19.”

But even for those beginning it for arthritis or Crohn disease, patients must still acknowledge the side effects and complications that can occur, such as

  • Cardiac disease resulting in cardiac failure, sometimes fatal
  • Bone marrow suppression (e.g. aplastic anemia) with severe blood disorders
  • Muscle weakness
  • Psychiatric effects, such as suicidal thoughts

What about this azithromycin?

This also has “yet to demonstrate safety and efficacy in humans diagnosed with or exposed to COVID-19” (CDC).

True, lots of people have taken a Z-Pak for respiratory infections and other things, even acne. And although it is an antibiotic (that is, anti-bacterial), it also has some antiviral properties since it mucks about with viral RNA proteins. Still, many adverse effects have been reported, such as

  • Chest pain and palpitations
  • Anemia and decrease in the white blood cell count
  • Liver impairment
  • Muscle damage
  • Kidney impairment

Thus, prescribed drugs require prescription because they require surveillance by a health care professional to make sure a patient doesn’t fall into the unlucky category.

The quagmire of where misinformation meets the unknown

Doctors have a lot of leeway in what drugs they can prescribe. Certainly, they can prescribe hydroxychloroquine and a Z-pak if they choose. However, patients must consider the conundrum into which doctors are placed. Even if doctors look up indications for medication in today’s ever-changing COVID-19 world, they will find things like,

“The decision to offer a patient an unproven or experimental treatment is between the doctor and the patient but must comply with national law. Where it is possible and feasible for the treatment to be given as part of a clinical trial, this should be done unless the patient declines to participate in the trial” (WHO); and

“Limited data available; optimal dose uncertain,”

“currently, there are no data to support use for prophylaxis, although studies are ongoing to assess the drug’s role for postexposure prophylaxis for household contact and health care workers,” and

“whenever possible, treatment should be given as part of a clinical trial” (FDA).

That being said, there are no national laws on off-label use of existing drugs for COVID-19. And family doctors are not authorized to establish a clinical trial for which his or her patient can decline. Translated: it’s like the wild, wild West out there when it comes to using drugs like hydroxychloroquine and azithromycin for COVID-19.

Fear of regulatory agencies—putting your doctor on the spot

All doctors in the US are governed by their respective states. The individual state boards are the “tough guys” in the medical sphere. Their positions are political appointments, and they are there to discipline doctors; often do this in what can seem arbitrary and narcissistic to justify their self-determined authority. They are required to investigate every complaint made by a patient, so if you were to develop, for instance, aplastic anemia and die, your doctor could be disciplined, with remarks placed officially on the National Databank, which can blackball a doctor from participating in Medicare and Medicaid, being on insurance panels for payment by insurers, or even being accepted onto the medical staff of their hospitals.

What to do? What to do?

Like it or not, you are best served by what is advised within the patient-physician relationship; and your doctor is best served by following established recommendations, even if those are slow in coming. There is a lot of sense in the reason some things are not rushed. If you’re dying, you should be allowed to try anything, from snake oil to magic potions, and whether hydroxychloroquine and azithromycin rise above this status won’t matter. But if you’re not terminal, tread intelligently along the guidelines that many learned people have established.

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This Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

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