Hydroxychloroquine...........

294,139 Views | 1854 Replies | Last: 4 mo ago by Jabin
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Cant Think of a Name said:

Hey, the guy above me copied me!

The Texas Medical Board (or whomever makes these decisions) wont authorize this drug treatment without a confirmed test. The tests are taking 5-7 days to get results, and are highly inaccurate. This treatment works best if administered in the first 7 days.

Anyone else see a problem here?


Our Government Agencies....... here to help!

While probably not entirely useless during regular times, these aren't regular times. This is a good time for bureaucrats to get the hell out of the way and let the brilliant minds in our country do work.
DTP02
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DTP02
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Dp
DTP02
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Cant Think of a Name said:

Hey, the guy above me copied me!

The Texas Medical Board (or whomever makes these decisions) wont authorize this drug treatment without a confirmed test. The tests are taking 5-7 days to get results, and are highly inaccurate. This treatment works best if administered in the first 7 days.

Anyone else see a problem here?


That's only part of the problem. Most of our currently available testing options use up healthcare personnel and PPE (and expose valuable HCWs to additional risk) which are needed for dealing with more severe cases, and the increase in testing adds additional backlog.

Until we get a fast testing regime in place that doesn't tie up needed resources, a treatment like hydroxychloroquine (which SEEMS like it might be effective but mostly in earlier stages) isn't going to be used to anywhere close to its potential. It can't be a "game changer" until we change the conditions of the game.

But that's only one side of the equation. IF we get the testing regime in place AND hydroxychloroquine (or some other protocol) is a game changing treatment, we still need to produce and distribute massive amounts of it. We clearly don't have anywhere close to enough right now which is why many states are limiting prescriptions.
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DTP02 said:

. We clearly don't have anywhere close to enough right now which is why many states are limiting prescriptions.



They aren't limiting it, they're wasting it by forcing Docs to give it to patients that won't see the best benefit from it.
DTP02
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Player To Be Named Later said:

DTP02 said:

. We clearly don't have anywhere close to enough right now which is why many states are limiting prescriptions.



They aren't limiting it, they're wasting it by forcing Docs to give it to patients that won't see the best benefit from it.


It's both. They are limiting it because of scarcity and the fact that they want to save it for those most likely to die, but (assuming the mounting anecdotal evidence is accurate) the treatment is less effective on folks in later stages.

We have to improve testing capacity to catch people earlier and supply to prescribe it earlier, assuming it works as hoped.
Cant Think of a Name
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But surely they are ramping up production of these medicines while they are ramping up production of the rapid tests, right?

...right?
culdeus
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Player To Be Named Later said:

DTP02 said:

. We clearly don't have anywhere close to enough right now which is why many states are limiting prescriptions.



They aren't limiting it, they're wasting it by forcing Docs to give it to patients that won't see the best benefit from it.
I don't get the sense that this is settled science, by any stretch. IANAD.
P.U.T.U
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The Texas board of Pharmacy is limiting it since doctors were writing prescriptions to themselves for hundreds at a time to give to their families and friends.
KidDoc
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BadMoonRisin said:

Reveille said:

DTP02 said:

74Ag1 said:

https://www.independentsentinel.com/hydroxychloroquine-keeps-people-alive-at-the-smith-center/


[NOTE: they have now changed the link. My summary below linked and summarized the original video. You may just have to take my word for it because I'm not going to try to hunt down the original link]

I was just coming to post this. Here's a direct link to the show, with the interview starting a little after the 12 min mark:



It's an interesting interview on several fronts, although it's a bit disjointed.

A quick and dirty recap:

- ID Clinic in NY has 70+ COVID patients. The majority are diabetic, pre-diabetic, and/or obese, so lots of high risk folks. Mentions some study from Seattle that zeroes in on the high incidence of diabetes and obesity among serious COVID patients and that this probably isn't getting enough attention

- He's giving hydroxychloroquine and Zithromax to all of his patients and has not lost any yet.

- here's the big point: none if the patients that had been on the protocol for even 3 days needed to be intubated

- of the ~20 patients who needed to be intubated they all came to the clinic fairly late in the infection and had been on the protocol for 2 days or less. He agrees that the protocol is a game-changer.

- he is concerned about side-effects of the protocol, especially given most of his patients have other risk factors, so they've been monitoring EKGs. Only two EKGs showed any concerning readings after starting the protocol.


I watched this night also! Was very interesting and looks very promising. He stated being an infectious disease doctor he hasn't read EKG's in over 20 years so had them read by an electrophysiologist and they found two with slightly widening QT Intervals. He did say that they were also on other medications that prolong QT Interval.

I think it also reiterated what we have been thinking and that diseases that cause weakening of the immune system like diabetes put you at high risk is serious disease!
Does the potential prolonged QT interval that is a side effect of this medication last only while the patient is on the medication, or is there a risk that it would prolong it permanently?
It is temporary but if you drag out that QT too long then get tachycardia that has potential to devolve into V tach which is lethal without shocking. Basically the ventricles do not have time to repolarize when the next impulse comes and it just starts twitching instead of pumping.
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aginlakeway
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P.U.T.U said:

The Texas board of Pharmacy is limiting it since doctors were writing prescriptions to themselves for hundreds at a time to give to their families and friends.
This is a fact. First-hand knowledge. (from pharmacy side)
P.U.T.U
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aginlakeway said:

P.U.T.U said:

The Texas board of Pharmacy is limiting it since doctors were writing prescriptions to themselves for hundreds at a time to give to their families and friends.
This is a fact. First-hand knowledge. (from pharmacy side)
Spouse is a pharmacist so that is how I knew what the board was doing.
FTAG 2000
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To the docs, are you guys modifying approach at all with this?

Sister is a medical consultant up in Colorado and shared that one of her facilities is having great success with the HCQ / Zpac combo.

She said they're starting anti-virals and antibiotics as soon as someone's got symptoms, and also admitting those in 'risk' groups who have initially mild presentations.

Said getting them started early is key, but they haven't lost a patient yet.
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AG 2000' said:

To the docs, are you guys modifying approach at all with this?

Sister is a medical consultant up in Colorado and shared that one of her facilities is having great success with the HCQ / Zpac combo.

She said they're starting anti-virals and antibiotics as soon as someone's got symptoms, and also admitting those in 'risk' groups who have initially mild presentations.

Said getting them started early is key, but they haven't lost a patient yet.


To be clear, they aren't waiting for a positive test first, right, just symptom onset?
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AG 2000' said:



Sister is a medical consultant up in Colorado and shared that one of her facilities is having great success with the HCQ / Zpac combo.


Said getting them started early is key, but they haven't lost a patient yet.


Sounds like your chances of beating this thing are pretty dependant on where you live and what facility you go to.

Here in Texas we have a lot of "well, good luck" going on apparently. Then there's places like this.

I'm scared to death that if I get this I'll end up at a facility that pretty much wishes me the best of luck.

With my risk factors, I really don't want to just hope for the best with no treatments until possibly too late.

dermdoc
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AG 2000' said:

To the docs, are you guys modifying approach at all with this?

Sister is a medical consultant up in Colorado and shared that one of her facilities is having great success with the HCQ / Zpac combo.

She said they're starting anti-virals and antibiotics as soon as someone's got symptoms, and also admitting those in 'risk' groups who have initially mild presentations.

Said getting them started early is key, but they haven't lost a patient yet.
Preaching to the choir. And limiting use of the meds to those with a positive test is ludicrous. I, a lowly pimple popper, can order antibiotics for everybody on here for anything basically with no regulation.

Supply issues I get. Regulatory issues in a pandemic should disappear.

And as I have posted everywhere, I would much rather money being spent on producing plaquenil and azithromycin than tests.

Let docs treat their patients. And early on when it is obviously the most helpful. This should be the exact time you relax regulations, not tighten them.
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That's not how our country works though.
dermdoc
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Player To Be Named Later said:

That's not how our country works though.
And people want government run health care. Oy vey.
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FTAG 2000
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DTP02 said:

AG 2000' said:

To the docs, are you guys modifying approach at all with this?

Sister is a medical consultant up in Colorado and shared that one of her facilities is having great success with the HCQ / Zpac combo.

She said they're starting anti-virals and antibiotics as soon as someone's got symptoms, and also admitting those in 'risk' groups who have initially mild presentations.

Said getting them started early is key, but they haven't lost a patient yet.


To be clear, they aren't waiting for a positive test first, right, just symptom onset?
Correct. They're on the outskirts of Denver. Were getting told 5-7 day turnaround time on test results. The docs there agreed that the patients could very well be dead before they got results back.

So they're treating on symptoms. Said they even stopped asking the dumb questions like "have you been to China or Italy recently". They've got confirmed community spread in their county and city, set that aside as a screening question.

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dermdoc said:

Player To Be Named Later said:

That's not how our country works though.
And people want government run health care. Oy vey.


The bureaucracy and "government knows best" BS seems to be killing people right now from my perspective. It's sickening.

I have lots of faith in our DRs and medical minds finding ways to combat this. I have 0 faith that the govt agencies will get the hell out of the way and stop wanting their 15 minutes of fame. THAT probably scares me more than the virus.
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P.U.T.U said:

The Texas board of Pharmacy is limiting it since doctors were writing prescriptions to themselves for hundreds at a time to give to their families and friends.


The board needs to get the **** out of the way IMO and let docs treat their patients.
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AG 2000' said:

DTP02 said:

AG 2000' said:

To the docs, are you guys modifying approach at all with this?

Sister is a medical consultant up in Colorado and shared that one of her facilities is having great success with the HCQ / Zpac combo.

She said they're starting anti-virals and antibiotics as soon as someone's got symptoms, and also admitting those in 'risk' groups who have initially mild presentations.

Said getting them started early is key, but they haven't lost a patient yet.


To be clear, they aren't waiting for a positive test first, right, just symptom onset?
Correct. They're on the outskirts of Denver. Were getting told 5-7 day turnaround time on test results. The docs there agreed that the patients could very well be dead before they got results back.

So they're treating on symptoms. Said they even stopped asking the dumb questions like "have you been to China or Italy recently". They've got confirmed community spread in their county and city, set that aside as a screening question.




I wish more were able to do that. Waiting for a positive test is going to kill people
McInnis 03
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Derm, sounds like you need to call Abbott (gov, not labs) and give him an earful. If TX Bureaucracy is costing lives, I'm sure a good Aggie can get the message across to him.
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McInnis 03 said:

Derm, sounds like you need to call Abbott (gov, not labs) and give him an earful. If TX Bureaucracy is costing lives, I'm sure a good Aggie can get the message across to him.

Yeah, just imagine he is an umpire.
JD Shellnut
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Sounds like Colorado is the place to be!
dermdoc
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Thinking through this some more and real docs please do not laugh at me. Anti TNF drugs do not seem to block I L 6. Steroids do. I wonder if the best treatment for the cytokines storm might be the plaquenil cocktail, a TNF agent to keep neutrophils down, and bolus steroids to block I L 6 in lieu of specific I L 6 blocking agents.
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JJMt said:

Reveille said:

Pelayo said:

dermdoc said:

Yes you will get crucified if some one has an adverse reaction and maybe sued.

I agree completely! I believe you do what's right!

I have been sued once and won. And it still haunts me sometimes. But I know it is better to do what is right. And trust God to protect you.
Yep


I agree completely!
I agree completely, also, and I'm a lawyer!

I've often thought that one way to reform our tort system, including malpractice claims, is to make the losing plaintiff lawyer(s) have to pay the winning defendant's fees and costs. That would still keep the courthouse doors open for legitimate claims, but would ensure that the plaintiff lawyers made damn sure that the claim was legitimate before filing it.

Sorry for the derail. Back to the thread now.
I completely agree! This would dramatically lower malpractice premiums and the cost of medicine.
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Reveille
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dermdoc said:

With all due respect, the same thing can happen with Tylenol. I have used plaquenil for decades as have rheums I know with out ever hearing of this side effect. And it is interesting we used to have to check a G6pd. Weird.

With all due respect, I kind of throw caution out the door when I am dealing with a pandemic. And I would be pissed if a doc did not start me or my family on the cocktail if the meds were available.

And sir, I am in the cheap seats and you are in the front row. I am definitely not qualified.
I also have used plaquenil for almost 20 years. I wouldn't call it safe but it definitely not a dangerous drug. I have used in patients for RA, Lupus and malaria prophylaxis's. I have a had a few lab abnormalities and occasional QT prolongation but nothing major. All of my lab issues returned to normal within a few months of discontinuing the drug.

I don't use as much as a rheumatologist but I write it at least once a week if not more. But I agree with you that in a pandemic you do whatever you can to help the sick.
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PJYoung
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FriscoKid said:

McInnis 03 said:

Derm, sounds like you need to call Abbott (gov, not labs) and give him an earful. If TX Bureaucracy is costing lives, I'm sure a good Aggie can get the message across to him.

Yeah, just imagine he is an umpire.
Reveille
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BiochemAg97 said:

JB99 said:

Fitch said:

74Ag1 said:

JB99 said:

SUag said:




What's the point of this? Is he saying not to use it until it's definitive? What does this accomplish?

He is trying to defend his "wrong" position. He is a typical overly cautious Dr that wants to see all the clinical trials and tests that take a long time. Typical bureaucrat... slow.

All the use is saving lives but he want accept it. FDA has approved it.
Sir, this is not correct.

The drug is unproven for COVID-19 in a clinical setting, with or without azithromycin and zinc. There are a myriad of small-patient-count reports and anecdotes that encourage optimism, but nothing defendable right now. The trials and studies in New York and elsewhere are trying to answer whether it's a valid prophylactic, treatment, or otherwise. Timing, age, gender, hyer(hypo)tension, pre-existing conditions, blood type, all have a weight in decision-making for any drug. Doctors on these forums have acknowledged doubts about it working. Everyone involved is still trying to figure it out.

Think about the weight of making this drug an endorsed medical recommendation from the federal government of the United States without substantial evidence it works.

Literally billions of people would hang their hopes on it, on trials of 30 or 40 people at a time right now. Best case - it works and we have massive runs on supply. Worst case - it has minimal to no effect outside of the small study populations circulated to date, or worse, gives false hope.

Can we just pray for and support the people trying to figure out how to help?


Your worst case is literally nothing. You realize there is no treatment, none that is defendable. There's absolutely no good reason not to try and use this treatment. So we are going from having nothing and hoping we win the genetic lotterry and don't need a ventilator to having the possibility of some hope. Just consider one of your children or parents or yourself getting this disease. Are you going to discourage a doctor from prescribing this because iy's not definitive? Of course not.


The worst case is a bunch of morons decide there is a cure, break quarantine, and we stop flattening the curve.

Given the drinking aquarium cleaner, the covid19 parties, etc, there are a lot of morons in this country.
This is definitely always a concern as the public unfortunately is not that bright.
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DadHammer
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https://www.foxnews.com/media/dr-stephen-smith-on-effectiveness-of-hydroxychloroquine-with-coronavirus-symptoms-beginning-of-the-end-of-the-pandemic
dermdoc
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cisgenderedAggie said:

Marcus Aurelius said:

Hydrochloroquine has essentially no side effects. Remdesivir - not alot of data. Anectodally - nothing . Contraindicated with increased LFTS.


Hydroxychloroquine can cause irreversible retinal damage and sudden cardiac death.


I have actually reviewed the literature on retinopathy with anti malarials extensively. First of all, chloroquine is the one with actual real documented retinopathy and it is extremely rare. Hydroxychloroquine has basically never caused retinopathy except in one study which is highly questionable. And a one week treatment period has never caused any retinopathy. Ever.

I have used hydroxychloroquine along with my rheum buds at the med center and have seen basically no cardiac side effects. A prolonged QT interval for a week I would personally take.

Seriously, the side effects are minimal as far as meds go. I mean, millions of Zpacks are called out a year without a patient visit and azithromycin can cause cardiac stuff too. But no docs get baseline ekgs for either of these meds except for arrhythmia patients.

Let's use some common sense.
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DadHammer
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Infection_Ag11 said:

dermdoc said:

Anybody with symptoms should be treated with haz. And as early as possible.


While I respect your opinion I strongly disagree.

As an example, I have a friend in GI at a different institution currently managing a fulminant drug induced hepatitis from plaquenil in a resolved COVID case. Young guy who would have almost certainly been fine regardless but got an outpatient script for it. Now his COVID symptoms have completely resolved but he may end up needing a liver transplant.

Just be careful is all I'm saying.

Don't believe you.
Slaytebeling
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    Just to piggyback on what Dermdoc has said. Below are the risk factor for retinal toxicity. The thing to focus on is the total cumulative dose of 1,000 grams. None of these patients will get close to this. As an optometrist I have very little concern for retinopathy from patients taking this medication for COVID. Retinal toxicity is very rare in patients that take hydroxychloroquine long term for underlying autoimmune diseases.
  • daily dose greater than 400 mg (or, in people of short stature, a daily dosage over 6.5 mg/kg ideal body weight) or total cumulative dose of more than 1,000 g
  • medication use longer than five years
  • concomitant renal or liver disease (because the drug is cleared by both routes)
  • underlying retinal disease or maculopathy
  • age greater than 60 years.

On a side note my wife is an intensivist and she is not seeing improvement with hydroxychloroquine in the severe patients. However this is a small sample size (10 patients) and they are all in the ICU and very sick. She has more hope in the antivirals and IL-6 inhibitors for the ICU patients but it is still early. Luckily they were able to enroll patients in some of the studies and have most of the medications available.


Exsurge Domine
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I'm not a doctor, but from what I've seen, the hcq is pretty much worthless once the lungs are compromised. The entire benefit of it seems to be that it stops the lungs from being compromised. It doesn't make a lot of sense to lock the front door after the murderer is in the house
 
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