Plaquenil for corona

My Saturday post mentioned initial findings that the old anti-rheumatic drug Plaquenil (hydroxychloroquine) may have some significant activity against coronavirus. The Chinese Health Ministry guidelines on coronavirus have been stealthily and widely distributed. I saw both versions (translated and Mandarin) the same Saturday I made my post. The guidelines even made it to a GP friend of Mrs. Pharriss in Menlo Park, who today offered to prescribe a course of Plaquenil to her and her husband to have on hand. She asked for my comment.

Even President Trump mentioned hydroxychloroquine (Plaquenil) (and pronounced it correctly) at his news conference today.  So the stuff is definitely front burner.  Remember you heard it here first.  You take it for an established infection, not for prevention.  We’ve gone through stretches in the past several years when Plaquenil has been hard to get, and the price has more than tripled since 2015.  It’s an old drug, first approved for medical use in the U.S. in 1955.  One thing the Trump administration is trying to do is to get industries to ramp up their efforts to meet medical needs.  So cue the Plaquenil vats.  I’m not sure Fox has things entirely right here, when it says the FDA has approved “chloroquine” for immediate release https://www.foxnews.com/politics/trump-fda-experimental-drugs-coronavirus.  Rarely, a rheumatoid or lupus patient will respond better to chloroquine phosphate (Aralen), an older drug much less widely used but still prescribed for malaria prophylaxis and ameba infections. Both Plaquenil and Aralen were derived from the first synthetic antimalarial quinacrine (Atabrine), which was developed in 1931 by Germany’s Bayer, and also is occasionally prescribed for lupus or RA.  Atabrine was handed out by the buckets full to GIs in the Pacific during WWII to prevent malaria.  But so little Atabrine and Aralen is manufactured these days, patients have to get it from a compounding pharmacy.  Atabrine turns your skin a golden yellow (as the ironic GIs couldn’t help but notice as they yellowed taking a drug to prevent yellow jaundice) and your nails blue over time, but the 5 day courses for corona shouldn’t do that.  Also, all the antimalarials can sometimes trigger mania.  I’ve seen it happen in one of my own patients.  I thought she was just happy at how much better my drug was making her feel, till she went over the top and landed on the psych ward.  Also not likely with a short course.  My money’s on Plaquenil, especially since that’s what Mr. President said.

How about some pictures of the stars of this show?