Exploring Hydroxychloroquine: Uses, Controversies, and Ethical Concerns in the COVID-19 Era - Free Essay

Drugs on the News

Hydroxychloroquine drug has been in the global news in the recent past. Medical researchers and scholars have engaged in intensive research to determine the drug's effectiveness in the treatment of COVID-19, a disease caused by the coronavirus. The drug was approved in 1955 for medical use after satisfactory tests made in the United States. (2) The World Health Organisation (WHO) recognizes the drug as an essential medicine. (2) In 2017, the drug was ranked the 128th most commonly prescribed drug in the USA. (2) Hydroxychloroquine only comes as a tablet that is taken orally. The drug is mainly used to treat lupus erythematosus, rheumatoid arthritis, and malarial. (2) Additionally, the drug is mostly associated with effectiveness in the treatment of malaria among adults and children. Hydroxychloroquine works by killing the malaria-causing parasite and boosting the patient’s immunity against it in the future. (2) The paper examines the conceptual application of HCQ in the control of coronavirus across the country.

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Pharmacology of HydroxychroloquineHydroxychloroquine is manufactured in the form of a tablet, each containing 500mg of chloroquine phosphate and 200mg of hydroxychloroquine sulfate. (10) The dosage differs based on the patient's age and the treatment indication, as well as the intensity of the disease. High doses of about 2000mg hydroxychloroquine have been used to treat acute malaria. (10) Hydroxychloroquine is among the drugs that are known to have a long terminal. The drug also has 22 days of elimination half-life. (10) The drug can be noticed in the urine up to three months from when the last dose was taken. Therefore, the drug takes approximately three months to leave the human body completely. Hydroxychloroquine reaches its peak plasma concentration in 3 to 4 hours. (10) The drug has different brand names depending on the company responsible for the manufacture. Axenal, Ercoquin, Polirrheumin, Quensyl, and Dolquine are among the brand names that refer to hydroxychloroquine. (10) Ideally, the pharmacology of hydroxychloroquine describes its composition, use, and effectiveness.

Hydroxychloroquine Mechanism of Action

Hydroxychloroquine has different modes of action, which are determined by the disease the drug is intended to treat. In the treatment of rheumatoid arthritis, the drug works by blocking the toll-like receptors present in the plasmacytoid dendritic cells (PDCs). (9) The toll-like receptors trigger the production of interferon by recognizing the immune complexes that contain DNA. The interferon triggers the dendritic cells to mature and also transfers the antigen to the toll-like receptors. (10) Hydroxychloroquine decreases the receptor’s signaling, thus reducing the dendritic cell activation and the process of inflammation. (9) As a result, the drugs reduce the inflammatory effects caused by rheumatoid-related diseases.

As an antimalarial drug, hydroxychloroquine’s mode of action has not yet been fully resolved. However, there is a model of action that is already embraced in the treatment of malaria. Hydroxychloroquine inhibits the hemozoin crystallization, which is responsible for the aggregation of cytotoxic heme. (8) The aggregated cytotoxic heme builds in the malaria-causing parasite resulting in its death. By killing the parasite, the drug prevents the occurrence of further complications and treats the disease instantly. (10) Ideally, the effectiveness of hydroxychloroquine in malaria treatment is contributed by its actions on the disease-causing parasite, thus preventing further complications.

Hydroxychloroquine Associated Disease

Hydroxychloroquine is commonly associated with Malaria disease. Malaria is a parasitic disease whose parasites are transmitted from an infected person to an uninfected human by the female anopheles mosquito. The disease is a life-threatening condition that is common in developing and underdeveloped countries. (6) The parasites responsible for malaria disease are Plasmodium ovale, P. malariae, P. vivax, and P. falciparum. (6) The key signs of malaria are high fever, nausea, headache, shaking chills, vomiting, and abdominal pains. On heavy infestation, the parasites cause cerebral malaria, which is caused by the swelling of the brain blood vessels. (3) Additionally, the disease may fail organs such as the liver, kidneys, and spleen. The critical situation of the drug causes anemia since the parasites destroy the red blood cells. The lethal effects of the disease trigger the use of hydroxychloroquine to treat the condition to reduce the further complications and deaths caused by malaria. (6)

Pharmacodynamics Information of HydroxychloroquineHydroxychloroquine is a weak base and lipophilic, penetrates easily through plasma membranes, and accumulates in cytoplasmic vesicles, causing an increased pH from 4 to 6. (10) The changes in pH lower proteolysis effect by inhibiting the action of acidic proteases in these vesicles. (6) The higher pH of the vesicles in macrophages and other antigen-presenting cells alters normal functioning resulting in decreased secretion of proteins and, in return affecting the immune system by decreasing chemotaxis and phagocytosis processes. (10) Additionally, the alteration in pH inhibits the ability of plasmodia to proteolyze hemoglobin for energy. Hydroxychloroquine has a rapid onset of action that peaks within 1-2 hours. Its duration of action can last for several days and even up to a week.

Pharmacokinetics

Hydroxychloroquine is highly absorbed following oral administration. It has a bioavailability of 67-74%. (6) It is widely spread with high levels in red blood cells, crosses the placenta, and is available in breast milk, and has a 50% protein binding capacity in serum albumin. (8) Upon absorption, it is partially metabolized in the liver into active metabolite desethylhydroxychloroquine and inactive metabolites desethychloroquine and bides-ethyl chloroquine. About 50% is eliminated by the kidneys, whereas 16-21% is excreted in the urine in an unchanged form. (8) Other forms are excreted in sweat and the unabsorbed drug is in feces. The half-life of hydroxychloroquine is about 3-4 hours, and its clearance rate is 96ml/min. (6)

Ethical Issues

Hydroxychloroquine is associated with various controversial issues that are linked to its availability and usage. In recent, there has been a misuse of the drug by the medical practitioners. (6) The drug has been speculated to have healing effects on heart diseases. Therefore, some medical practitioners prescribe the drug for patients with heart conditions. The unethicality in the scenario occurs since the drug has not yet been proven safe for heart conditions. (6) Therefore, the improper administration of the drug for inappropriate conditions may result in lethal effects on the patient. (4) The drug is also associated with unethical issues that involve overselling. In the recent past, there has been speculation of the drug’s effectiveness in treating the COVID-19 disease. (6) Therefore, pharmacists have been overselling the drug, which risks the lives of healthcare consumers. The speculations on the use of the drug in treating COVID-19 have resulted in a shortage in the market. (5) As a result, rheumatologists have been forced to look for other drugs to use in the treatment of rheumatoids. (6) Ideally, the ethical issues associated with hydroxychloroquine revolve around the misuse and the use of the drug for inappropriate illnesses.

Reasons Why the Drug is in the News

In the recent past, hydroxychloroquine has hit the headlines of global news. With the rise of the COVID-19 virus, there has been speculation about the effectiveness of the drug in treating the disease. (2) The New York Times is among the newspaper that has highlighted the speculations in some of the articles. “Trumps Aggressive Advocacy of Malaria Drug for Treating Coronavirus Divides Medical Community” is an article published in The New York Times highlighting the use of hydroxychloroquine in the treatment of COVID-19. (1) The article describes President Trump’s advocacy for the use of hydroxychloroquine in treating coronavirus. (2) The advocacy has raised controversies among medical practitioners to argue against the president’s claims. In their argument, the medical experts state that Trump’s advocacy for the use of the drug is not based on scientific tests and research, which may cause more harm to the consumers. (1) The medical practitioners state that the advocacy aims at benefiting the pharmaceutical companies that Trump is a shareholder in. The presence of hydroxychloroquine in the news has resulted in an increase in ethical issues related to the drug as well as its shortage in the market. (7) Ideally, hydroxychloroquine is on the news for its relation to the Covid-19 worldwide pandemic.

Personal Thoughts

Hydroxychloroquine is an active drug in the management of malaria and rheumatoid. Therefore, the drug should be manufactured and used for the treatment of the two diseases. However, the presence of the drug in the news threatens human lives since it can be used inappropriately. For example, when one develops coronavirus symptoms, they may tend to use the drugs for treatment, which may result in lethal effects. Therefore, the advocacy of the drug without proper expertise research should be regulated to ensure the dissemination of only credible and reliable information. Ideally, the media should ensure they disseminate only the information from experts to avoid unethical issues in the community.

References

1. Baker P, Rogers K, Enrich D, Haberman M. Trump's aggressive advocacy of malaria drug for treating coronavirus divides the medical community. New York Times. 2020 Apr; 6. http://coronadrugs.net/files/trump_hydroxychloroquine.pdf

2. Browning, D. Pharmacology of chloroquine and hydroxychloroquine. Hydroxychloroquine and chloroquine retinopathy. Springer. 2020. https://link.springer.com/chapter/10.1007/978-1-4939-0597-3_2

3. Cowman, A., Healer, J., Marapana, D., Marsh, K. Malaria: Biology and disease cell. Science Direct. 167 (3), 610-624. 2020. https://www.sciencedirect.com/science/article/pii/S009286741631008X

4. El Rhazi, K., Adarmouch, L. Ethical issues related to the hydroxychloroquine treatment prescription for Covid-19. Ethics, Medicine, and Public Health. 14. 2020. https://reader.elsevier.com/reader/sd/pii/S2352552520300852?token=29A7E94F454B1DFADAE4223AF2BB3A7806BEC5CF04803ED1FEDFE10D07C76D4492CA206B0EF61C1679C16463234DD087

5. Erickson, T., Chai, P., Boyer, E. Chloroquine, hydroxychloroquine and COVID-19. Toxicology Communications. 4(1), 40-42. 2020. https://www.tandfonline.com/doi/pdf/10.1080/24734306.2020.1757967

6. Garrido-Cardenas, J., Cebrian-Carmona, J., Gonzalez-Ceron, L., Manzano-Agugliaro, F., Mesa-Valle, C. Analysis of global research on malaria and Plasmodium. International Journal of Environmental Research and Public Health. 16, (1928). 1-11. 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603864/pdf/ijerph-16-01928.pdf.

7. Geleris, J., Sun, Y., Platt, J., Zucker, J., Baldwin, M., Hripcsak, G., Labella, A., Manson, D., Kubin, C., Barr, G., Sobieszczyk, M., Schluger, N. Observational study of hydroxychloroquine in hospitalised patients with Covid-19. The New England Journal of Medicine. 2020. https://www.nejm.org/doi/pdf/10.1056/NEJMoa2012410

8. Herraiz, T. Chloroquine and hydroxychloroquine as antimalarials and antivirals against SARS-CoV-2: The hemin factor. 2020. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwic-J22upzrAhU1SxUIHbZTAFUQFjAAegQIBRAB&url=https%3A%2F%2Fosf.io%2F8d6xv%2Fdownload%2F%3Fformat%3Dpdf&usg=AOvVaw3aGnMwxcBWw1nxVhv_XeBS

9. Nirk, E., Reggiori, F., Mauthe, M. Hydroxychloroquine in rheumatic autoimmune disorders and beyond. EMBO M...