The use of chloroquine against the coronavirus is the subject of studies and tests; understand the risks | Coronavirus

The World Health Organization (WHO) states that the use of chloroquine combined with the antibiotic azithromycin is one of the four combinations of drugs that are being tested in 74 countries and whose results are monitored by the organization.

Despite this, the organization informed the G1 that “so far, no pharmaceutical product has been shown to be safe and effective in treating Covid-19.”

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Currently, use in Brazil is authorized by the Ministry of Health only in critically ill patients and also in those in moderate condition already admitted to hospitals, provided that the doctor and the patient agree to the use.

For this reason, doctors ask the population NOT to self-medicate with these or other remedies. The first news about the drug led to a shortage and caused Anvisa to put the drug on the list of controlled drugs. In addition to malaria, the drug is used against rheumatism, joint inflammation, and lupus.

In Brazil, on March 25, the Ministry of Health authorized the use in the treatment of hospitalized patients with serious conditions. The launch came with the warning that there were “gaps in knowledge” about the drug. On April 3, the ministry expanded the indication of use also for moderate cases, when patients receive hospital care.

On Tuesday (7), the Minister of Health, Luiz Henrique Mandetta, said that the ministry will not take action against doctors who prescribe chloroquine for patients in the early stages of the disease. “If he (the doctor) takes individual responsibility, there is no obstacle. No one is going to withhold anyone’s income, “said Mandetta.

On Wednesday, Mandetta reaffirmed that there is no guidance for the indiscriminate use of the drug. He recalled that most of those infected do not have complications and recover without problems. And that among the elderly, there is a risk of side effects.

“Is it possible that if we administer them en masse, more than 60, more than 70, more than 80, this medicine will protect them or they will have arrhythmia, they will need a bed in the ICU and they will have a heart attack? myocardial infarction? Asked the minister.

Mandetta said those questions are in the hands of those conducting the studies and asked the Federal Council of Medicine (CFM) for a position, until April 20, on the use of the drug.

Also Wednesday, the United States Center for Disease Control and Prevention (CDC) withdrew from its website’s guidelines on the use of chloroquine. Now, the CDC website warns that “there are no medications or other treatments approved by the Food and Drug Administration (FDA) to prevent or treat Covid-19.”

Experts ask for caution

Fiocruz National School of Public Health researcher Margareth Dalholm says chloroquine has not substantially reduced mortality in the countries that tested it.

“The world does not treat Covid-19 with chloroquine alone, quite the opposite. Experience has shown that the result in reducing mortality was nil. There are other alternatives that were used for critically ill patients, with pneumonia caused by it, “he explains.

“There are countries that are testing biological anti-inflammatory solutions, they are testing the use of plasma infusion. Several therapies are being tested, but so far neither has been shown to be better than the other and is unable to substantially reduce mortality. “- Margareth Dalholm, pulmonologist

For Alexandre Naime, infectious disease specialist and professor at Unesp, there is “little evidence that it is beneficial”.

“I tell my students, my residents, that it’s like gambling on the Mega Sena. I would like to win in the Mega Sena, but my perception that I will win is small. I have already prescribed chloroquine or hydroxychloroquine for over 30 patients. It looks like I’m going to do this because I have no choice. So who do I do it for? For patients who are moderate or severe, for mild cases I do not, because then I think that the cost, that is, adverse events can be more dangerous than the benefit, “he explains.

The medication can cause side effects on vision, heart and liver.

Wladimir Queiroz, a doctor specializing in infectious diseases at the Emilio Ribas Hospital and a consultant for the Brazilian Society of Infectious Diseases, argues that use should only occur in controlled situations.

“My opinion is that it can be used as long as the patient is in a clinical trial setting. Where he is surrounded by all the cares. Here’s the thing: We have hints that it works, which doesn’t mean it works safely. So, in the context of a clinical trial, the safety of a patient comes first, even before effectiveness “- Wladimir Queiroz, infectious disease physician

“The data we have is not enough to hit the hammer and say it works. But we are not going to stop studying. In many services, chloroquine is administered indiscriminately, who am I compared to what is now known to science to applaud or condemn the services they are doing in this way? I just think it still lacks stronger and more consistent data. And soon we will have it.

“Experimental rescue therapy”

The Brazilian Society of Infectious Diseases (OSE) is against the indiscriminate use of remedies against malaria. He says, in a note, that he “considers the use of hydroxychloroquine to treat Covid-19 as an ‘experimental rescue therapy’.”

“Its use must be individualized and evaluated by the prescribing physician, preferably with the participation of an infectious disease specialist, evaluating its possible side effects and possible benefits. Among the main adverse effects, the following stand out: blood dyscrasia, gastrointestinal disorders (nausea, vomiting, diarrhea), muscle weakness, emotional lability, rashes, headache, visual turbidity, hair discoloration or alopecia and dizziness, “he says the note.

The entity recommends the prescription only in severe cases and without other treatment options or in clinical studies.