During the first months of the coronavirus (COVID-19) pandemic, some physicians used the malaria drugs Plaquenil (hydroxychloroquine) and Aralen (chloroquine) as potential treatments for the coronavirus. These drugs are no longer recommended for emergency use in hospitalized patients with COVID-19. Patients treated with these drugs should be aware of possible side effects, including eye problems.
What are Plaquenil (hydroxychloroquine) and Aralen (chloroquine)?
- These medicines, taken as pills, have been used for decades to treat malaria.
- Hydroxychloroquine is also prescribed for rheumatoid arthritis, systemic lupus erythematosus and other autoimmune disorders.
- In March 2020, the US Food and Drug Administration (FDA) approved Plaquenil and Aralen for the emergency treatment of patients hospitalized with COVID-19.
- On June 15, 2020, the FDA revoked emergency authorization of these drugs for Covid-19 after their review of multiple studies showed these drugs were unlikely to provide any protection against the coronavirus.
- The FDA also determined that the risk of serious heart problems outweighed any potential benefits of these drugs.
Why did doctors explore using malaria drugs to treat coronavirus?
Some patients with severe COVID-19 have experienced organ failure and death, apparently because their immune system kept attacking long after the virus was eliminated. Hydroxychloroquine helps calm the immune response. That’s why it works so well for autoimmune conditions like lupus. In addition, it is thought to decrease the ability of the virus to multiply in the body. Physicians had hoped these drugs might help the body recover sooner from COVID-19 and decrease the risk of some of the more serious complications of the disease.
These drugs were being prescribed at a higher dose and for a shorter period of time for COVID-19 than for other conditions.
Are hydroxychloroquine and chloroquine safe?
Hydroxychloroquine and chloroquine are generally considered safe for most people. Side effects may include stomach pain, nausea, vomiting, headache and sometimes itchiness.
However, these drugs can cause health complications, including retinal damage, in some people. Also, people with psoriasis, heart arrhythmia, kidney disease or liver disease may be at risk of complications from the drugs.
There are reports of abnormal heart rhythms in coronavirus patients who were treated with hydroxychloroquine and chloroquine. This heart problem was seen often when these drugs were given in combination with azithromycin or other medicines.
Will hydroxychloroquine and chloroquine damage my retina?
Patients who rely on hydroxychloroquine and chloroquine to treat autoimmune conditions (such as lupus) rarely have eye damage. Only about 1% to 2% of patients develop retinal problems during a 5-year course of treatment.
There are certain conditions that may make people more prone to retinal damage from hydroxychloroquine and chloroquine. Patients with the highest risk tend to be older than 50, have a history of a retinal disease such as macular degeneration or have previously taken tamoxifen for breast cancer.
COVID-19 patients were given roughly twice the dosage of these drugs than normally given for autoimmune problems, but they only took them for 1-2 weeks. It is unlikely that this dose will cause retinal problems.
What are signs of retina problems from malaria drugs?
Patients who develop retinal damage from hydroxychloroquine and chloroquine may not notice changes in their vision at first. As the damage worsens, symptoms may include:
If you notice any visual changes after taking these drugs, call your ophthalmologist right away.