HYDROXYCHLOROQUINE (Plaquenil), AND CHLOROQUINE INFORMATION

The Alabama Board of Pharmacy does not intend to set policy about which drugs you should dispense or about the best decisions for your circumstances. We are receiving so many calls asking that we rule from one perspective or from the opposite perspective regarding the use of malaria drugs for COVID-19.

These are facts which we have discovered and wish to share with you.

• Hydroxychloroquine is used in the treatment of arthritis to help relieve inflammation, swelling, stiffness, and joint pain, and also to help control the symptoms of lupus erythematosus (lupus; SLE)

• Since these drugs were mentioned in Presidential press conferences, there has been a significant increase in prescriptions for the drug to be used for COVID-19.

• We have received calls from patients who take the drug regularly to relieve symptoms of arthritis or lupus, and are now unable to refill the medication.

• The National Association of Boards of Pharmacy reports, and we have received reports, that most new prescriptions are being held "in case" a person develops COVID-19.

• We only wish to inform you of the pattern we see developing and suggest you use your professional judgment for the welfare of your patients.

• Hydroxychloroquine has an extremely long half-life due to tissue absorption. A period of 6 months is required to achieve 96% of steady-state levels of hydroxychloroquine with the usual once daily, oral dosage regimen. Once the drug is stopped, it can take up to 5 months for the drug to be fully removed from the system. Patients experiencing side effects will have to live with those effects for months. (Br J Clin Pharmacol. 1989 Jun; 27(6): 771–779.)

• At this time there is no research which provides reliable evidence that these drugs will be successful treatments for COVID-19. There is evidence that the drugs have serious side effects in some patients and there are warnings to use the drugs cautiously in children. (Coronavirus (COVID-19) Update: FDA Continues to Facilitate Development of Treatments) Pharmacists have the right to fill prescriptions for drugs written off label. A written prescription, however, may not be protection for you if the patient has major problems.

• Information for Patients: Patients should be informed of the early signs and symptoms of toxicity such as rash or visual changes. Patients must see their physicians promptly in case of the appearance of these or of any unusual effects. Periodic laboratory tests may be recommended in some patients. Patients should be fully informed of the potential risks of the use of PLAQUENIL, especially in pregnancy and in children.