It was observed that between 7% and 28% of hospitalized have acute myocardial injury [1-4]. When one looks at Epocrates (database for drugs which is why I'm not linking anything here) the severe adverse reactions of hydroxycholoroquine include QT prolongation, cardiomyopathy, and torsade de pointes. Just to define some things here, QT prolongation is the time from your Q wave to your T wave, or the start of an electrical depolarization on your cardiac ventricles to repolarizations. QT elongation usually leads to cardiac arrest. Torsade de pointes is a syndrome where your cardiac ventricles beat so quickly that your heart paradoxically cannot fill up with blood potentially, and usually, leading to sudden cardiac death.
Giving someone who has had essentially a heart attack (by definition COVID patients have elevated troponin which is the marker we use to assess if one has had a heart attack) is probably a bad idea so my question is: why would we celebrate a drug that has massive cardiac adverse effects as a side effect? Don't get me wrong I understand that there are drugs that are even worse. Cyclosporine is the first line immunosuppresant for kidney transplant. Do you know what one of the most common adverse effects of cyclosporine is? Kidney failure. But we don't know what is causing the kidney failure in a kidney transplant (rejection vs adverse effect) so we have to biopsy. Kidney biopsy is a very invasive procedure, FYI. My point is, maybe waiting for double blind placebo research here is the best case. Also, I made this exact same point on here a month ago and people told that they would take my dose if it came to that and at this point I will say go ahead.
> between 7% and 28% of hospitalized have acute myocardial injury
So, for a younger (< 60) otherwise healthy person whose chance of death with covid is less than 1%, it would seem ill advised to take this medication at the onset of symptoms, unless the the disease itself causes similar or higher rates of heart damage.
It's only advised if it actually works. If it doesn't work, then there's still no point in taking it because the side effects are still bad. And there's no good evidence that it even works, and some mild evidence that it doesn't.
Yes, and even if it did work to reduce severity of the illness (agreed that there is no evidence of this), it seems like for low-risk people, the risks of heart damage outweigh the benefits of taking it. After all, what's an extra week or two of illness vs a 7-28% chance of heart damage.
Yup. I'm in a relatively low risk factor group and got over COVID-19 at home, no hospitalization necessary and nothing stronger than acetaminophan needed. I don't think a decent change of permanent heart damage was what I needed through all this. Also, I would have had a higher chance of being hospitalized from the side effects of the HCQ than from the COVID-19, which is really not what the hospitals need right now.
The HCQ doesn't seem remotely merited based on its potential side effects unless you are in a higher risk factor for the disease, and of course even then, it's only merited it's actually efficacious (which it's seeming so far it isn't).
Potentially, yes. But again, we need more data before we can establish lucid guidelines on this therapy.
My hypothesis is that it's not going to be hydroxychloroquine that will be the miracle drug. There are better "hypothetical" alternatives that aren't getting as much mainstream attention but have a more realistic potential for working.
Giving someone who has had essentially a heart attack (by definition COVID patients have elevated troponin which is the marker we use to assess if one has had a heart attack) is probably a bad idea so my question is: why would we celebrate a drug that has massive cardiac adverse effects as a side effect? Don't get me wrong I understand that there are drugs that are even worse. Cyclosporine is the first line immunosuppresant for kidney transplant. Do you know what one of the most common adverse effects of cyclosporine is? Kidney failure. But we don't know what is causing the kidney failure in a kidney transplant (rejection vs adverse effect) so we have to biopsy. Kidney biopsy is a very invasive procedure, FYI. My point is, maybe waiting for double blind placebo research here is the best case. Also, I made this exact same point on here a month ago and people told that they would take my dose if it came to that and at this point I will say go ahead.
[1] https://www.ncbi.nlm.nih.gov/pubmed/32169400
[2] https://www.nejm.org/doi/full/10.1056/NEJMoa2004500 [3] https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.0... [4] https://jamanetwork.com/journals/jamacardiology/fullarticle/...