Hydroxychloroquine Myth Busters

Dr K K Aggarwal, President CMAAO, HCFI and Past National President CMAAO

Hydroxychloroquine causes retinal toxicity

No. Retinal toxicity, which can result in irreversible retinopathy, is mainly associated with high daily doses and more than 5 years of use of chloroquine or hydroxychloroquine in the treatment of rheumatic diseases. 

This side effect is seen with long-term use of chloroquine. With hydroxychloroquine, it is only a caution only after years of use.

The risk of toxicity depends on daily dose and duration of use. At recommended doses, the risk of toxicity up to 5 years is <1% and up to 10 years is <2%. However, it increases to nearly 20% after 20 years. Even after 20 years, a patient without toxicity has only a 4% risk of converting in the subsequent year. [Ophthalmology 2016;123(6):1386-94]

Hydroxychloroquine causes QT prolongation

Only if used with azithromycin, it can cause QT prolongation.

It cannot be given in 60 plus age

No, there is no such evidence. All international travelers have been taking it once a week as malarial prophylaxis

It can cause hemolysis in G6PD deficiency

There is no evidence. While manufacturer’s labeling recommends that caution should be exercised while using chloroquine in patients with G6PD deficiency due to a potential for hemolytic anemia, there is limited data to support this risk. Many experts consider chloroquine, given in usual therapeutic doses to WHO Class II and III G6PD deficient patients, as probably safe (Cappellini 2008; Glader 2017; Luzzatto 2016; Youngster 2010). Safety is; however, unknown in Class I G6PD deficiency (severe form of the deficiency associated with chronic hemolytic anemia) (Glader 2017). A study in West Africa including 74 G6PD deficient patients (predominantly Class III deficiency) reported that there were no cases of hemolysis following exposure to usual doses of chloroquine (Mandi 2005). The ACR Rheumatology guidelines do not specify the need to evaluate G6PD levels before initiating therapy (Singh 2015).

It has many contraindications

No. Only contraindication is hypersensitivity to chloroquine, 4-aminoquinoline compounds, or any component of the formulation.

Hydroxychloroquine is contraindicated in children

No, it is not given for COVID-19 in children as they have high chances of natural recovery.

It is an OTC drug

No, it is a prescription drug and given only on the prescription of RMP.

It can damage the kidneys

There is no evidence.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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