I think this is unsafe advice, specifically using chloroquine and hydroxychloroquine without medical supervision.
These are not benign drugs (chloroquine being worse) and you are advising people use it while unwell with an emerging and poorly understood disease that could potentially alter its safety and pharmacokinetic/dynamic profile, and without any consideration for potential other health issues people have or medications people are taking (eg many antidepressants and anyone with diabetes).
If you have chloroquine/hydroxychloroquine, you should go see your healthcare provider before taking it do the baseline tests and discuss relevant side effects for your individual situation.
If you have COVID-19 and have chloroquine/hydroxychloroquine, you should not be taking them without medical supervision. If you are young and healthy, you are more likely to have side effects from the drugs than have a severe infection.
If you are unwell enough to be admitted to hospital, bring your drugs with you and ask the doctors to prescribe it while you are an inpatient, with appropriate monitoring, using your own supply (and keep it with you, rather than in the hospital’s drug cupboard—lots of theft of hospital supplies happening)
I’ve added some information about possible side effects to my comment. Obviously “with medical supervision” would be preferable, so sure talk to your doctor on the phone about it first if you can. (I think visiting a doctor’s office is too risky at this point.) But if your doctor can’t or won’t talk to you about taking chloroquine/hydroxychloroquine, and you don’t have preexisting conditions that make chloroquine/hydroxychloroquine more dangerous for you, it seems to me safer to take it than not. Unfortunately I’m unable to find quantitative information about the risk of side effects (UpToDate says “Frequency not defined” under “Adverse Reactions”), so it’s hard to make a really informed decision about this. Perhaps to be safer, one could take chloroquine/hydroxychloroquine at home at a lower dosage than is recommended for severely sick hospitalized patients? Would you agree with that, or do you think “young and healthy” should refrain from taking any dosage, absent medical supervision? If so, what is that based on? (E.g., are you a doctor with first-hand experience or some other source of information about chloroquine side-effects?)
Hydroxychloroquine is pretty well tolerated from what I’ve seen (never seen chloroquine given we have a safer alternative). The most common side effect is nausea/vomiting/diarrhoea and this is the only thing I could find a rate on (~10%). There are also a collection of rare, severe side effects.
Some of my concerns are:
Most of our safety data would be targeted at use in relatively well patients with rheumatological or dermatological disease, not acutely unwell infective patients (I have no idea about its safety profile in malaria other than it’s not really used anymore due to resistance)
Unknown dosage—as you suggested a lower dose might be safer but could also be below the therapeutic dose (the studies DO seem to use a fairly high dose)
The chloroquines come with a risk of QT prolongation; coronavirus comes with a risk of myocarditis—I would expect one would have much higher rates of arrhythmias. Also worsened by the other QT prolonging medication one would be on by then (azithromycin), and electrolyte abnormalities present in critical illness/from GI side effects of the drugs and infection. Admittedly, myocarditis seems to be a late development and the patient would be in ICU already, rather than early in the disease
Most of this probably comes down to the unknown—this is extremely early days into the investigation of using hydroxychloroquine for COVID19. I don’t think we know enough about this to be using it outside of the medical setting. Maybe my risk threshold would be for its earlier use in those over 60 or those with isolated hypertension? I’m unsure. This could all change within 1-2 weeks as I’d expect there’ll be significantly more data.
I think this is unsafe advice, specifically using chloroquine and hydroxychloroquine without medical supervision.
These are not benign drugs (chloroquine being worse) and you are advising people use it while unwell with an emerging and poorly understood disease that could potentially alter its safety and pharmacokinetic/dynamic profile, and without any consideration for potential other health issues people have or medications people are taking (eg many antidepressants and anyone with diabetes).
If you have chloroquine/hydroxychloroquine, you should go see your healthcare provider before taking it do the baseline tests and discuss relevant side effects for your individual situation.
If you have COVID-19 and have chloroquine/hydroxychloroquine, you should not be taking them without medical supervision. If you are young and healthy, you are more likely to have side effects from the drugs than have a severe infection.
If you are unwell enough to be admitted to hospital, bring your drugs with you and ask the doctors to prescribe it while you are an inpatient, with appropriate monitoring, using your own supply (and keep it with you, rather than in the hospital’s drug cupboard—lots of theft of hospital supplies happening)
Edit: for formatting
I’ve added some information about possible side effects to my comment. Obviously “with medical supervision” would be preferable, so sure talk to your doctor on the phone about it first if you can. (I think visiting a doctor’s office is too risky at this point.) But if your doctor can’t or won’t talk to you about taking chloroquine/hydroxychloroquine, and you don’t have preexisting conditions that make chloroquine/hydroxychloroquine more dangerous for you, it seems to me safer to take it than not. Unfortunately I’m unable to find quantitative information about the risk of side effects (UpToDate says “Frequency not defined” under “Adverse Reactions”), so it’s hard to make a really informed decision about this. Perhaps to be safer, one could take chloroquine/hydroxychloroquine at home at a lower dosage than is recommended for severely sick hospitalized patients? Would you agree with that, or do you think “young and healthy” should refrain from taking any dosage, absent medical supervision? If so, what is that based on? (E.g., are you a doctor with first-hand experience or some other source of information about chloroquine side-effects?)
Hydroxychloroquine is pretty well tolerated from what I’ve seen (never seen chloroquine given we have a safer alternative). The most common side effect is nausea/vomiting/diarrhoea and this is the only thing I could find a rate on (~10%). There are also a collection of rare, severe side effects.
Some of my concerns are:
Most of our safety data would be targeted at use in relatively well patients with rheumatological or dermatological disease, not acutely unwell infective patients (I have no idea about its safety profile in malaria other than it’s not really used anymore due to resistance)
Unknown dosage—as you suggested a lower dose might be safer but could also be below the therapeutic dose (the studies DO seem to use a fairly high dose)
The chloroquines come with a risk of QT prolongation; coronavirus comes with a risk of myocarditis—I would expect one would have much higher rates of arrhythmias. Also worsened by the other QT prolonging medication one would be on by then (azithromycin), and electrolyte abnormalities present in critical illness/from GI side effects of the drugs and infection. Admittedly, myocarditis seems to be a late development and the patient would be in ICU already, rather than early in the disease
Most of this probably comes down to the unknown—this is extremely early days into the investigation of using hydroxychloroquine for COVID19. I don’t think we know enough about this to be using it outside of the medical setting. Maybe my risk threshold would be for its earlier use in those over 60 or those with isolated hypertension? I’m unsure. This could all change within 1-2 weeks as I’d expect there’ll be significantly more data.