hydroxychloroquine []

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====== Hydroxychloroquine ======
**Hydroxychloroquine** is a highly applicable [[drug]] processed out of extracts from the bark of the tropical [[Cinchona]] tree. Hydroxychloroquine is one of the [[4-aminoquinoline medicines]].

===== History =====
See [[https://roundingtheearth.substack.com/p/the-chloroquine-wars-part-i|Drugs of the Cinchona Tree]] at [[Rounding the Earth]].

===== Medical Uses =====
Hydroxychloroquine is one of the most repurposed drugs in the history of [[medicine]].
  * Hydroxychloroquine as [[Antimalarial]]
  * Hydroxychloroquine as [[Antiviral]] including [[https://www.campfire.wiki/doku.php?id=covid-19:treatments:drug_therapies:hydroxychloroquine|SARS-CoV-2 infection and COVID-19 disease]]
  * Hydroxychloroquine as treatment for [[autoimmune disorders]]

==== Coronavirus ====
During the [[COVID-19 pandemic]], hydroxychloroquine become controversial.

Prior to the pandemic, there was a substantial body of literature suggesting that hydroxychloroquine would most likely help stave off a SARS-CoV epidemic. The following paragraphs are taken from a [[Rounding the Earth]] article.((March 25, 2021 | [[Mathew Crawford]] | [[Rounding the Earth]] | [[https://roundingtheearth.substack.com/p/the-chloroquine-wars-part-vii?s=w|Why Did Dr. Anthony Fauci Leave Hydroxychloroquine Off the Early Pandemic Research Priority List?]]))

In late 2004, in the wake of the SARS-CoV outbreak that claimed over 8,000 lives across nearly 30 nations, Belgian researcher Els Keyaerts and her team published a paper in the journal Biochemical and Biophysical Research Communications entitled "In vitro Inhibition of Severe Acute Respiratory Syndrome Coronavirus by Chloroquine".((October 8, 2004 | Els Keyaerts et al | In vitro inhibition of severe acute respiratory syndrome coronavirus by chloroquine | [[https://pubmed.ncbi.nlm.nih.gov/15351731/|doi: 10.1016/j.bbrc.2004.08.085]]))
Keyaerts and her cohorts tested the antiviral properties of chloroquine phosphate on a line of kidney cells extracted from an African green monkey. Using amounts of CQ similar to those used to treat malaria patients, the researchers noted successful antiviral effects (killing of the virus) and cytostatic effects (inhibition of viral replication). The researchers concluded, “Chloroquine, an old antimalarial drug, may be considered for immediate use in the prevention and treatment of SARS-CoV infections.”

Keyaerts’s paper was not the first to explore the effects of CQ and other quinolines on viruses. For decades, scientists have found CQ to be effective in vitro, in vivo, or in humans against flaviviruses such as dengue virus, retroviruses such as HIV, myxovirus, Zika virus, and picornaviruses such as poliovirus. And it does this while working against cell damage caused by some viruses. Less than a year after Keyaerts et al published, an American research team led by Martin J. Vincent published a study in Virology Journal titled "Chloroquine is a potent inhibitor of SARS coronavirus infection and spread," reporting in vitro viral inhibition both as prophylaxis and treatment. From that research:

In addition to the well-known functions of chloroquine such as elevations of endosomal pH, the drug appears to interfere with terminal glycosylation of the cellular receptor, angiotensin-converting enzyme 2. This may negatively influence the virus-receptor binding and abrogate the infection, with further ramifications by the elevation of vesicular pH, resulting in the inhibition of infection and spread of SARS CoV at clinically admissible concentrations.

This interference with the ACE2 receptor adds to the rationale for testing HCQ efficacy on those infected with SARS-CoV-2, and COVID-19 patients.

This level of versatility of HCQ is quite unusual among drugs. Few drugs are successfully repurposed, so we might wonder: What is it about HCQ that makes it so useful? While nobody knows that answer completely, at least some of HCQ’s medicinal potential stems from a wide array of effects. First, for reasons researchers do not fully understand, HCQ and CQ block the parasites that cause most malaria from entering the blood stream via the CD147 pathway, which is noteworthy because CD147 is one of the cellular pathways through which SARS-CoV-2 passes (into the bloodstream where it can cause the debilitating microthrombotic effects associated with COVID-19).

In 2007, a team of French infectious disease experts experienced with these medications reviewed the literature, noting the rise of coronavirus epidemics, and predicted that HCQ and CQ would prove even more widely applicable to new diseases through the twenty-first century. 

It is clear that for many years, scientists focused on HCQ as a drug with potential to shut down the next coronavirus outbreak. Many rationale papers and opinion pieces were published in medical journals, and a few even in blogs, both years before the pandemic and during its early months. At the onset of the SARS-CoV-2 pandemic, hundreds of researchers quickly began registering trials to study the effects of HCQ or CQ both in the U.S. and around the world. In fact, through April 27, 2020, 46 of the 68 repurposed medicine clinical trials registered for prophylaxis (68%) proposed testing HCQ out of all possible options! 

Clearly, HCQ was broadly considered the obvious first candidate among researchers as a drug to treat the next coronavirus epidemic (even if our media didn't want to speak a word about it).

There was one single rationale paper for repurposing medicine published during the early going of the pandemic that did not include any discussion at all of hydroxychloroquine, despite its being the obvious first choice. That's the one that has NIAID Director Dr. Anthony Fauci's name on it.

===== Interactions =====

===== Pharmacology =====
Hydroxychloroquine is a drug with a "Goldilocks zone" dosage level where too little is generally ineffective, but too much can be toxic.

==== Contraindications ====

==== Safety Data ====
[[ThermoFisher Scientific]] safety data sheet for hydroxychloroquine.((Creation: July 18, 2006 | Revision: December 24, 2021 | [[ThermoFisher Scientific]] | [[https://www.fishersci.com/store/msds?partNumber=AC263010250&productDescription=HYDROXYCHLOROQUINE+SULF+25GR&vendorId=VN00032119&countryCode=US&language=en|Hydroxychloroquine Safety Data Sheet]]))

=== Adverse Events ===