In 1799, the entire kingdom of Mysore came under British control. For several days, the British soldiers celebrated their victory, but after a few weeks, many of them began to feel ill due to malaria. This is not surprising because the location was a very swampy area inhabited by an army of mosquitoes.
The locals have developed immune system resistance to malaria over the centuries. To some extent, local culinary traditions contributed to protection against this disease, as they are big fans of spicy food. British soldiers and officers, who suddenly found themselves in the harsh conditions of India, were hit hard by malaria.
To overcome the mosquito infestation, the British army very quickly moved its forces from Srirangapatnam to Bangalore. Unfortunately, the problem of malaria still persisted because mosquitoes were doing their business in Bangalore as well.
Around the same time, a chemical called quinine was developed by scientists. Despite the lack of knowledge of this substance and large-scale studies, quinine could be used to treat malaria. The malarial crisis in the British army came at just the right time, so quinine was imported in large quantities and distributed to all British soldiers.
What does Hydroxychloroquine have to do with it, you ask? Soldiers, including healthy individuals, were instructed to take quinine regularly and in precise dosages. The purpose of this was to develop immunity to malaria.
Although the sick recovered quickly, many still got sick. Later, it turned out that they did not take the medicine as prescribed as it was very bitter. Fortunately, bitter quinine mixed with juniper-based liqueur became not only less bitter but actually sweet.
This juniper liqueur was Gin. Gin & Tonic drink was an instant hit with British soldiers. The army has even begun giving soldiers several bottles of gin along with “tonic water” (quinine) as an essential part of their monthly rations. Thus, the soldiers themselves could prepare Gin and Tonic and also use it every day to develop immunity.
So, Gin & Tonic became a popular cocktail and still remains a popular drink. Quinine, which was called Tonic (without Gin), was also widely prescribed by physicians for patients in need of treatment for fever or any infection. Over the years, quinine and its derivatives have been further used and widely prescribed by Indian physicians.
One of the descendants of quinine, called hydroxychloroquine, eventually became the malaria drug that has suddenly gained the status of the most sought-after drug in the world during the COVID-19 pandemic, which we will talk about next.
Besides malaria, hydroxychloroquine is currently prescribed to treat rheumatoid arthritis and lupus. It is known for its immunosuppressive and anti-inflammatory properties.
How to use
The drug is taken only orally. Each dose should be taken with a meal or with a glass of milk. After ingestion, it is rapidly and completely absorbed.
- Malaria prevention and treatment
Prevention of acute attacks of malaria is recommended 2 weeks in advance of potential contact. If the medication cannot be taken in advance, then the initial dose can be doubled. It is split into two doses and administered at a 6-hour interval. Preventive treatment should be continued for 8 weeks after leaving the endemic area. The prevention dosage is prescribed by the doctor based on the weight. If the individual is sick, the prevention dosage is typically doubled.
- Rheumatoid arthritis treatment
The cumulative effects of hydroxychloroquine are present. While adverse effects can develop quite quickly, the medication’s healing impact can take several weeks to become apparent. Hydroxychloroquine should be stopped if the patient’s condition does not significantly improve within six months after starting the treatment. As with the previous case, the medication should be prescribed by the doctor who will calculate not only the right dosage and treatment plan but will also be able to weigh all the benefits and risks.
Hydroxychloroquine Uses in Covid
Coronavirus is an acute viral disease characterized by a predominant lesion of the respiratory system and the gastrointestinal tract. In severe cases, people may need intensive care, including mechanical ventilation.
After the first rumors about the effectiveness of Hydroxychloroquine against COVID-19 appeared, doctors in several countries immediately began prescribing the drug. In India, for example, it was also used for prevention. Healthy people did not lag behind and began to buy packs of unsafe medicine. Considering the panic and number of death the pandemic has caused and the fact that there was no known treatment, it can be understandable that people tried every possible way to save lives.
Meanwhile, there were numerous studies, based on which Hydroxychloroquine is not recommended for use by WHO and FDA. Data obtained to date cannot yet be considered sufficient for the use of Hydroxychloroquine in the treatment of patients with COVID-19 in routine practice. This drug is characterized by a large number of potential interactions with drugs prescribed to COVID-19 patients.
Moreover, the use of this antimalarial drug slows down the normalization of the inflammatory response of the body and lengthens the time of patients’ stay in the hospital. As studies have shown, the side effects and even deaths overweight any potential benefit. HHC should not be used in the treatment of COVID-19.
Contraindications and precautions
This medication should not be prescribed to individuals who have hypersensitivity to Hydroxychloroquine and to 4-aminoquinoline derivatives or to other components of the drug. Retinopathy (including a history of maculopathy) is also a contraindication. Children under 6 years of age should not take this medication. If long-term treatment is necessary, children have an increased risk of developing toxic effects. As with many medications, women who are pregnant should not use the drug.
Individuals with visual disorders should be aware that this medication can cause adverse ophthalmic reactions (risk of progression of retinopathy and visual disorders). Individuals with the following health problems should take the medication with caution:
- hematological diseases;
- neurological diseases;
- late stages of cutaneous porphyria and psoriasis (risk of worsening), simultaneous administration of drugs that can cause skin reactions;
- renal failure and/or liver failure, hepatitis, simultaneous administration of drugs that can adversely affect the function of the liver and/or kidneys;
- deficiency of glucose-6-phosphate dehydrogenase;
- gastrointestinal diseases;
- hypersensitivity to quinine (the possibility of cross-allergic reactions);
- conduction disorder of the heart and hypertrophy of both ventricles;
- cardiomyopathy.
Due to the risk of hypoglycemia, the drug should be administered with caution to patients both taking and not taking hypoglycemic drugs.
Side effects of Plaquenil Generic
When using this medication, the digestive system can suffer, which might result in diarrhea, stomach cramps, nausea, and other side effects. Individuals may become irritable and may experience mania, psychosis, hallucinations, paranoid or suicidal thoughts, and other disturbances.
As the dosage increases, the risk of retinopathy increases, which is damage to the retina that can lead to blindness. To calculate the risk of retinopathy, doctors even came up with a special calculator, according to which doses of more than 5 mg per kilogram of body weight should be taken with caution.
In rare cases, severe and sometimes deadly, skin lesions, as well as hematopoietic disorders, are possible. Also, potentially lethal consequences of using the drug can be a prolongation of the QT interval of the heart and cardiomyopathy.
Overdose
The symptoms of an overdose include cardiotoxicity. With chronic intoxication, hypertrophy of the myocardium of both ventricles is likely. Other overdose symptoms include decreased blood pressure, neurotoxicity (headache, dizziness, irritability, convulsions, coma), visual impairment, and respiratory and cardiac arrest. Overdose is especially dangerous for young children, even taking 1 to 2 g of the drug can be fatal.
Treatment consists of gastric lavage, prescription of medications that reduce the metabolic load on the organs of excretion and detoxification, forced diuresis and alkalinization of urine to increase the excretion of 4-aminoquinoline in the urine, symptomatic therapy, and maintenance of vital functions. It is necessary to control the concentration of sodium in the blood serum and constant medical supervision for at least 6 hours after the relief of symptoms.
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