UGA medication experts answer common questions they’re receiving from patients
As COVID-19 cases in the U.S. continue to climb, health care professionals are desperately searching for new treatments to fight the disease. In the most serious cases, they’re often turning to off-label use of a variety of drugs to try and stop disease progression.
But with constant reporting on possible new treatments comes a lot of confusion. From overhyped drug combinations that may or may not hasten recovery from the disease to the myth that ibuprofen makes you more susceptible to the virus, pharmacists across the country have heard it all.
Medication experts play a crucial role in keeping people safe and healthy, with expertise in the chemical, biological and physical properties of medications.
Here, Chris Bland and Tim Brown, faculty from the University of Georgia’s College of Pharmacy, take on some of the most common questions they’re getting from patients.
Should I start taking hydroxychloroquine prophylactically?
The answer to this question is an emphatic no.
Hydroxychloroquine, which is better known under its brand name Plaquenil, is FDA-approved to fight malaria but is more commonly used in the U.S. to treat autoimmune diseases such as rheumatoid arthritis and lupus. Hydroxychloroquine, often paired with the antibiotic azithromycin, has been recently touted as a potential treatment for COVID-19. Neither of these medications are antivirals.
But the studies that showed some improvement in hospitalized patients given the drug combo were incredibly small, primarily in non-critically ill patients and poorly designed, Bland said. Bland and Brown both agree that people shouldn’t start hopping on the bandwagon just yet, as the meds come with serious risks. The drug combo has been shown to cause heart problems, such as arrhythmias, in some patients.
“I don’t believe at this time that anybody outside of the hospital setting should be a candidate for these two medications used together for COVID-19,” Bland said. “In the hospital, we can perform cardiac monitoring of these patients to ensure safety. There are very limited data for effectiveness with definite risk of cardiac toxicity. That’s why we don’t recommend it to outpatients.”
Perhaps more importantly, the supply of hydroxychloroquine in the U.S. is dwindling.
“One of the side effects of people now just jumping on this drug to use it for COVID-19 is that a lot of these patients that have been on this drug chronically are having problems finding it,” said Bland. “A lot of pharmacists and pharmacies that I’ve been talking to in the community are out of it to the point where they don’t have any to give to these patients.”
Are there other potential treatments that look promising?
The antiviral medication remdesivir, an antiviral medication, is one of the most promising treatments. The drug isn’t FDA approved to treat anything, which means significantly more paperwork and jumping through legal hoops to get it on the market if it proves effective. But studies in hospitalized COVID patients are rolling out across the state. In some hospitals, severely ill patients given the drug improved in just a couple of days.
But again, there haven’t been any large-scale studies to prove the drug’s efficacy.
“Without clinical trials, who knows if those people just got lucky because they had mild symptoms or if the drug actually had an impact,” Brown said.
Does ibuprofen make me more susceptible to coronavirus?
Short answer: No.
There is no scientific evidence that links the disease to ibuprofen pain relievers. But, like all medications, they’re not right for everyone.
Although available over the counter to treat mild aches and pains, drugs like Motrin and Advil don’t come without risks, said Brown. People who have had a heart attack or are in congestive heart failure, those with a history of stomach ulcers or gastrointestinal bleeds, and individuals with kidney disease should avoid ibuprofen, which has been linked to an increased risk of heart attack, stroke and bleeding in the stomach or intestine.
If you’re not sure if you fall into the danger category, talk to your pharmacist.
What about ACE inhibitors?
A quick Google search will turn up thousands of stories trying to link the common drugs used to treat high blood pressure and heart failure to poor outcomes with coronavirus. But there’s no proof using an ACE inhibitor ups your chances of ending up in the hospital should you contract the virus.
More importantly, Bland said, people who abruptly stop using the drugs set themselves up to drastically increase their blood pressure or exacerbate the heart problems the ACE inhibitors were treating, possibly requiring them to visit their provider or wind up being hospitalized.
“One of the last places you want to be is admitted to the hospital where they could be potentially taking care of COVID-19 patients and have a higher risk of exposure,” Bland said. “You never want to start or stop anything that is a chronic medication without talking to a health care provider such as a pharmacist or your physician.”
Although many physicians are moving to telemedicine options when feasible, patients who are having trouble getting through to their regular provider for refills shouldn’t worry. One of Gov. Brian Kemp’s executive orders in March granted pharmacists the ability to renew medications for chronic conditions for up to three months, if they are unable to reach the provider.
Tim Brown, director of interprofessional education in the College of Pharmacy, is hosting new episodes of PharmCast for the Community, a podcast/YouTube video series featuring expert commentary from health care professionals fighting COVID-19. You can find new episodes at https://rx.uga.edu/pharmcast/.
[This article originally appeared in UGA Today, on April 15, 2020,by Leigh Beeson]