Hydroxychloroquine is a malaria drug that has been studied as a possible treatment for the novel coronavirus. It has been politicized as President Donald Trump has promoted the drug — in May he said he took it as a preventative — while doctors and public health officials warned against it until more could be learned about how effective it is against COVID-19.
In the spring, the Food and Drug Administration approved emergency use of hydroxychloroquine and chloroquine as COVID-19 treatments, but in June, regulators revoked that emergency authorization. Citing reports of heart complications and studies showing that the drugs can cause more harm than good, the FDA said the drugs’ unproven benefits “do not outweigh the known and potential risks.”
But some local doctors are finding success when prescribing hydroxychloroquine to COVID-19 patients.
Dr. Lowell Phipps of Highland Village said that he has treated a couple dozen patients with it and has seen fast and effective results.
“All of them noticed significant symptomatic reaction in the first 24 to 48 hours,” he said. “Symptoms were greatly reduced or went away entirely.”
Phipps said the treatment ought to be prescribed within the first seven days of symptoms, and shouldn’t be given to patients who have been at risk for heart issues or are on medicines that would put them at risk for heart arrhythmias.
“Individual patients need to be taken care of in an individual fashion,” Phipps said. “I wouldn’t treat everyone the same.”
Regarding the studies that didn’t find success with hydroxychloroquine, Phipps said he has read that in those studies, the patients are usually given the drug too late or in too high an amount.
“There’s a toxic level of hydroxychloroquine and if you get to that level or above, there are significant side effects,” Phipps said. “My total dose is only two grams, much less than the total dose most studies have used.”
Phipps added that he expects better therapies will be found or developed in the near future. But for now, “I think it’s a very good choice. I’ve had excellent results with my patients, and other physicians I’ve talked to do very well with it. For patients with significant shortness of breath, I also advise the use of oral inhaled steroids to help with those symptoms.”
Other doctors in the area, though, are not as likely to prescribe hydroxychloroquine. Dr. Harvey Castro, Chief Executive Officer at Trusted Health Physicians, said that due to possible heart issues, the doctors at Trusted ERs are more likely to use it with patients that are being transferred to a hospital, where they can be continuously monitored.
“It’s all about risk vs. benefits,” Castro said. “The FDA said it’s not approved for this use.”
For Castro, it is imperative that patients and the public be educated about the risks, the science and the pros and cons of different treatments.
“It’s really about education, truly informed consent,” Castro said.
Castro said the fact that using the malaria drug has become a political issue makes it harder for physicians, but “Who do you trust for medical advice, the President or the National Institutes for Health? The FDA or CDC, that’s who I would trust, personally.”
Castro said Trusted ER is more likely to prescribe dexamethasone, a steroid that a study found can significantly improve COVID-19 survival.
“There are more studies that show it helps,” Castro said. “The harms are very little compared to other treatments. Those are easier to write for our patients.”