Download HCQs.docx questions and answers and more Exams Advanced Education in PDF only on Docsity!
Use of Hydroxy-Chloroquine (HCQ) As Prophylaxis for COVID 19 The National Taskforce for COVID - constituted by the Indian Council of Medical Research (ICMR) recommends the use of hydroxyl-chloroquine (HCQ) for prophylaxis of COVID -19 infection for a high-risk population. The advisory provides for placing the following high-risk population under chemoprophylaxis with hydroxyl- chloroquine (HCQ)
- Asymptomatic Healthcare Workers involved in the care of confirmed cases of COVID-
- Asymptomatic household contacts of laboratory-confirmed cases.
The protocol recommended by the National Task Force has been approved by the Drug Controller General of India for restricted use in an emergency situation The Important Points to be remembered during the HCQ Prophylaxis are:
- The placing of healthcare workers under chemoprophylaxis should not instill a sense of false security. They should follow all prescribed public health measures such as frequent hand washing, respiratory etiquettes, keeping social distancing of one meter and use of PPE
- They should self-monitor their health and report to health authorities
NB:- It is reiterated that the intake of the above medicine should not instill a sense of false security Recommendation for empiric use of hydroxyl-chloroquine for prophylaxis of COVID-19 infection Eligible Individual:
- Asymptomatic Healthcare Workers involved in the care of confirmed cases of COVID-
- Asymptomatic household contacts of laboratory-confirmed cases. Dose:
- Asymptomatic healthcare workers involved in the care of suspected or confirmed cases of COVID-19: 400 mg twice a day on Day 1, followed by 400 mg once weekly for the next 7 weeks; to be taken with meals
- Asymptomatic household contacts of laboratory-confirmed cases: 400 mg twice a day on Day 1, followed by 400 mg once weekly for the next 3 weeks; to be taken with meals Contraindications:
- The drug is not recommended for prophylaxis in children under 15 years of age
- The drug is contraindicated in persons with a known case of retinopathy, known hypersensitivity to
immediately contact the health facility, get tested as per national guidelines and follow the standard treatment protocol
- All asymptomatic contacts of laboratory-confirmed cases should remain in home quarantine as per national guidelines, even if they are on prophylactic therapy
- Simultaneously, proof of concept and pharmacokinetics studies to be taken up expeditiously. Findings from these studies and other new evidence will guide any change in the recommendation. Hydroxychloroquine Sulfate The hydroxychoroquine sulfate is widely available as in the trade name of Plaquenil.
The hydroxychloroquine sulfate belongs to 4-aminoquinolone compound The therapeutic class of hydroxychloroquine sulfates are antiprotozoal, antirheumatic, lupus Erythematosus suppressant. Pregnancy risk category is C category that means risk to the fetus can’t be ruled out (Inadequate human studies) Indications for Hydroxychloroquine Sulfate To prevent malaria To treat chronic discoid and systemic lupus Erythematosus To treat acute or chronic rheumatoid arthritis To prophylaxis and treatment of COVID-19(under studies and trials) Dosages of Hydrochloroquine Sulfate To Prophylaxis against COVID – 19 400 mg twice a day on Day 1, followed by 400 mg once weekly for the next 7 weeks; to be taken with meals To prevent Malaria Tablets Adult: 400 mg the same day of each week starting 2 week before entering endemic area and continuing until departure from endemic area Infants and Children:
Initial 400 to 600 mg daily for 4 to 12 weeks. Maintainance dose 200 mg to 400 mg daily. Hydrochloroquine Sulfate Mechanism of Action It may mildly suppress the immune system, inhibiting production of rheumatoid factor and acute phase reactants. Hydroxychloroquine also accumulates in WBCs, stabilizing enzymes such as collagenase and proteases that cause cartilage breakdown. These actions may decrease symptoms of rheumatoid arthritis and lupus Erythematosus. Hydroxychloroquine also binds to and alters DNA of malaria parasite to prevent it from reproducing. It also may increase the pH of acid vesicles, which interferes with vesicle function and may inhibit parasitic phospholipid metabolism in erythrocytes, thereby halting plasmodial activity Inhibits infection of cells by SARS-CoV-2 in vitro but there is no adequate studies available on it Hydroxychloroquine interactions Aurothioglucose: Increased risk of blood dyscrasias Digoxin: Increased digoxin concentrations Hydroxychloroquine side effects The drug can cause heart rhythm problems, severely low blood pressure and muscle or nerve damage. Taking it outside of a scientific experiment adds the risk of not having tracking in place to watch for any of these side effects or problems and quickly address them if they do occur.
Central Nervous System: Abnormal nerve conduction, ataxia, dizziness, emotional lability, headache, irritability, lassitude, nervousness, neuromuscular sensory abnormalities, nightmares, psychosis, seizures, vertigo Cardiovascular system Cardiomyopathy (Prolonged high doses) Eye, Ear, Nose and Throat Abnormal pigmentation (bullseye appearance) or colored vision, blurred vision, central scotoma with decreased visual acuity, corneal deposits, decreased corneal sensitivity, diplopia, irreversible retinal damage, halo vision, lassitude, macular edema or atrophy, nerve- related hearing loss, nystagmus, photophobia, tinnitus Endocrine system: Hypoglycaemia Gastrointestinal System: Abdominal cramps, anorexia, diarrhea, elevated liver function test results, fulminant hepatic failure, nausea, vomiting Hemetology SysteM: Agranulocytosis, Aplastic anemia, hemolysis, hemolysis (in patients with G6PD), leukopenia, thrombocytopenia Muskuloskeletal System: Atrophy of proximal skeletal muscle groups, depressed tendon reflexes, muscle weakness Respiratory System:
Instruct patient to take drug with meals or milk to minimize stomach upset Tell patient to take hydroxychloroquine exactly as prescribed because taking too much may cause serious adverse reactions and taking too little or skipping doses decreases effectiveness Caution patient to notify takes drug for rheumatoid arthritis or lupus Erythematosus about possible visual reactions and the need for periodic eye examinations. Caution patient to notify prescriber about troublesome adverse reactions. Hydroxychloroquine dosage may need to be adjusted or drug stopped
