Memo to Prescribers: Plaquenil (hydroxychloroquine) and COVID-19

From: Jessica Nouhavandi, PharmD  

Preliminary in vitro studies have illustrated that Plaquenil (Hydroxychloroquine Sulfate) might be a treatment option for patients who are diagnosed with COVID-19. 

Our pharmacy has received an unprecedented number of phone calls from doctors seeking information regarding Plaquenil dosing for COVID-19.  Many prescribers have reported feeling pressure to prescribe this drug as a precautionary measure by their patients. We are concerned that this is leading to the over-prescription of Plaquenil, which is a strong immuno-modulatory and anti-inflammatory agent that can cause serious side effects. 

Furthermore, we are urging prescribers to be vigilant of the potential risks associated with families hoarding this medication in their homes without valid diagnosis. There are many patients who require Plaquenil to both prevent and treat malaria in addition to treating lupus and acute and chronic rheumatoid arthritis. We are concerned that the increasing demand for Plaquenil during the COVID-19 outbreak could lead to decreased availability of the drug for those patients who need it to treat chronic conditions. 

We have observed a variety of dosing recommendations, both in publications on preliminary findings regarding Plaquenil and COVID-19 and from doctors associated with our pharmacy. However, it is important to remember that there have been no set, agreed-upon guidelines for the therapeutic or prophylactic dosing for COVID-19 depending on risk level and symptom severity. Our pharmacists have been reviewing preliminary studies from Berlin, S. Korea and China, and we are advising prescribers who call in on a case-by-case basis. We are taking a very cautious and conservative approach in our recommendations. 

As healthcare practitioners, let’s be vigilant of over-prescribing and unnecessary prescribing of Plaquenil during this uncertain time. We have a responsibility to our patients and to the communities we serve. 

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Dr. Jessica Nouhavandi is the lead pharmacist, co-founder, and co-CEO of Honeybee Health, an accredited online pharmacy based in Los Angeles that provides patients with direct access to affordable prescription medications. Dr. Jessica earned her bachelor’s degree in bioethics and became a Doctor of Pharmacy from Western University of Health Sciences in 2011.

Jessica Nouhavandi