Hydroxychloroqine (C18H26ClN3O), also known as HCQ, is an inexpensive medication sold under the name Plaquenil. Prior to COVID-19 it was most commonly used to treat malaria, and also currently to treat lupus. The package insert for Plaquenil describes its mostly minor potential side effects, some of which occur at much higher doses than what is used to treat COVID-19.
It has been used by the physician Dr. Vladimir Zelenko as a part of successful treatment for coronavirus and was recommended for such by President Trump (see: Vladimir Zelenko's coronavirus treatment). Specifically, Dr. Zelenko used hydroxychloroqine, azithromycin (an antibiotic) and zinc as a part of his treatments to his patients.
Never-Trumpers in government and hospitals block early use of this medication, and instead either withhold it from patients entirely or delay it until the end stage of the patient's life when medications are least effective. Other governments (such as Texas), wanting to make sure current patients had a supply for their pre-existing medical needs, permitted it only with a positive COVID-19 diagnosis.
See also: Vladimir Zelenko's coronavirus treatment
The Food and Drug Administration (FDA) allows hydroxychloroquine to be used as an off-label coronavirus treatment.
According to WebMD.com: "The practice, called 'off-label" prescribing, is entirely legal and very common. More than one in five outpatient prescriptions written in the U.S. are for off-label therapies." In other words, originally approved for use in humans as an anti-malarial drug, it can be prescribed by a treating physician for other uses.
On May 30, 2020, the Grand Rapids Herald-Review stated:
|“|| Dr. Vladimir Zelenko serves as a Primary Care Physician in suburban New York City—the epicenter of this outbreak. “I knew that the virus would hit our area hard due to our population density—we have 32,000 people living in one square mile. So I did my own research looking at what had been done in other countries that experienced the virus before us as well as looking at treatments developed for the SARS outbreak in 2003 (another coronavirus). I developed my own protocol of a three drug cocktail: HCL, Azithromycin, and Zinc. In the last few weeks I have seen 1,450 patients with COVID symptoms. I divided my patients into two groups: high risk and low risk. The low risk patients (under age 60 and healthy) statistically get better without treatment, so I sent them home to rest and get over the virus. I gave my drug cocktail to 405 high risk patients (over age 60 or with underlying health problems) whose conditions were most severe. The accepted rate of COVID mortality at that time for high risk patients was 5%, so if I had just relied on ventilators I could have expected to see 20 of my patients die. But using these three drugs I only lost two patients, one of which was very old and had been chronically ill. This was a significant order of magnitude better than expected outcomes.”
Dr. Zelenko explains the rationale behind his treatment program. “The zinc is what kills the virus and zinc occurs naturally in the body but has a hard time penetrating the cell where the virus lives. What the hydroxychloroquine does is open a channel into the cell so the zinc can enter and stop the virus from replicating. Adding an extra dose of zinc to the cocktail has been shown to improve outcomes by about 25%. Meanwhile, the azithromycin stands guard to combat any secondary bacterial infection that may crash the party and cause pneumonia.”
After seeing the effectiveness of his treatment regimen, Dr. Zelenko stated, “I realized what I had, and I felt like a front line soldier who had stumbled across some very important intelligence—some valuable information that needed to be communicated to the 5-star general because that information could be used to win the war.”
Within a few weeks, Dr. Zelenko had published video reports of his findings and was in touch not only with the US Coronavirus Taskforce, but with over a dozen governments around the world from Russia, to South Africa, to Peru. Four weeks ago the government of Brazil began implementing Dr. Zelenko’s protocol, and he explains their results: “One week ago the Brazilians published a study revealing a 95% reduction in deaths after this drug cocktail was introduced for use in their government hospitals.”
"Early Hydroxychloroquine Is Associated with an Increase of Survival," reports a study in Spain on May 5, 2020:
- Methods: We enrolled all 18-85 years old inpatients from Central Defense Hospital “Gómez Ulla”, Madrid, Spain, who were hospitalised for COVID-19 and had a definitive outcome (dead or discharged). We used a statistical survival analysis to detect treatment differences associated with in-hospital death. Results: We analysed first 220 medical records. 166 patients met the inclusion criteria. 48,8 % of patients not treated with HCQ died, 22% of those treated with hydroxychloroquine (p=0,002). According to clinical picture at admission, hydroxychloroquine increased the mean cumulative survival in all groups from 1,4 to 1,8 times. This difference was statistically significant in the mild group.
- Conclusions: in a cohort of 166 patients from 18 to 85 years hospitalised with COVID-19, hydroxychloroquine treatment with 800mg added loading dose increased survival when patients were admitted in early stages of the disease. There was a non-statistically significant trend towards survival in all groups, which will have to be clarified in subsequent studies.
1. HCQ inhibits the attachment of the amino acid region 111-158 of the viral spike of COVID-19 to gangliosides
2. The COVID-19 replicative cycle that could be inhibited by HCQ is the pH-dependent viral endocytosis.
3. Transcription could be impeded by HCQ.
4. HCQ may block the posttranslational modifications of viral proteins within the endoplasmic reticulum and trans-Golgi network vesicles, perhaps by impairing the maturation of its M protein .
5. HCQ could be helpful concerning cell-signaling, in particular through MAPK
From the CDC:
- "Hydroxychloroquine can be prescribed to adults and children of all ages. It can also be safely taken by pregnant women and nursing mothers."
- "CDC has no limits on the use of hydroxychloroquine for the prevention of malaria. When hydroxychloroquine is used at higher doses for many years, a rare eye condition called retinopathy has occurred. People who take hydroxychloroquine for more than five years should get regular eye exams."
The usefulness of zinc to HCQ treatments is explained by a study published in September 2020, "Hydroxychloroquine, a drug used initially in the management of COVID-19, is an ionophore that transports Zinc across the hydrophobic cell membrane. Moreover, evidences specifically suggest that Zinc supplemented with antiviral drugs containing Zinc-ionophores precisely targets and binds to SARS-CoV-2 preventing its replication within the infected host cells2."
According to the website ResearchGate.net: "Several studies have reported that zinc has a broad-spectrum antiviral activity against a variety of viruses. Increased intracellular Zinc concentrations inhibit RNA-dependent RNA polymerases and other proteins essential for the completion of different phases of the virus life cycle. Further, zinc also helps to maintain robust immune responses by producing cytokine and by modulation of immune cell activity."
Reduction in binding effect
[W]e have provided clear evidence that HCQ can dissociate aPL IgG–β2GPI complexes from phospholipid bilayers. Additional studies will be needed to further define the molecular mechanism(s) for this dissociation and its possible role in modifying the APS disease process.
- Plaquenil Uses, etc. - Drugs.com
- Marchione, Marilynn (March 23, 2020). 'Game changer'? Trump-touted malaria drugs spur hope, shortages. Washington Times. Retrieved March 28, 2020.
- Off-Label Drug Use: What You Need to Know
- Is a combo of chloroquine and Zinc a cure for coronavirus?
- Doctors discover effective, life-saving treatment for Covid-19 By Rev. Mark Peske Our Redeemer Lutheran Church, Grand Rapids Herald-Review, May 30, 2020
- https://www.preprints.org/manuscript/202005.0057/v1 (emphasis added).
- Is a combo of chloroquine and Zinc a cure for coronavirus?