Are You at Risk of Sudden Death from Hydroxychloroquine?

[EngMac]

I found this on The People's Pharmacy.

peoplespharmacy.com/article...?

[Finvola]

The effects of this drug on people taking anti-arrhythmic drugs has been ignored in the hype to pass it off as a cure. The Rxlist Drug Interactions site gives the same warnings about it:

'hydroxychloroquine oral and flecainide oral both increase QTc interval'.

[Dawsonmackay]

I think it would be best to give some chemical theory on this drug and its origins. The short answer though is yes, the chloroquine family is bad news for anyone with arrhythmia. Long ago, before 1822, when malaria was called the ague, there was a tree bark from the cinchona tree that displayed some healing effect from drinking its pulverized bark. In 1822, two French chemists isolated the chemical properties in the bark, and found that the "quines" held efficacy. The cinchona tree came in three bark colors: white, yellow and red and each had a varying amount of the quine, so later in the century a chemical derivative was manufactured and thus, one would not be susceptible to a varying efficacy of the natural bark. A by-product of cinchona, or cinchone or any of its derivatives is "Quinine," and one must know that "Quinine," is insanely bitter. "Quinine," as I found out one day is quite deleterious for Afib patients because it lowers the heart rate and our AF gets really mean - like I was at the point of fainting - HELLO!! Dawson are you still with us? Hello, can you hear us Dawson? Other really bad effects from any "quine" chemical or organic is tinnitus, deafness, fainting, and in too much quantity, red line.

Just to let you know, cinchona is a malarial poison and that is why, it works.

[EngMac]

I forgot to mention that in this article that long QT interval is clearly explained. Also in one of the links in the article is a list of all the drugs that lengthen QT; and there is a huge number. Anyone with a left bundle branch block, which lengthens QT interval, must be even more careful about the drugs they are prescribed. As I have said before, my family doctor told me heart doctors often do not do extensive analysis on all the drug effects and interactions since most people can take the drugs without problems. Only a few people die and he said the cost of hospitalization does not warrant checking each patient. So you probably need to be aware and insist that your doctor justify the real need for one of these drugs and then weigh the risk. Flatlining outside of a hospital is usually not a good thing.

[Bagrat]

Interesting. I'm already on Flecainide low dose and tamoxifen both of which can cause long QT interval . All HCPs inc. pharmacist unconcerned.

[Hidden]

I think we need to know if it actually works on a large scale trial before we start panicking and then work out if the risk of dying from covid-19 is greater

The voice of reason

youtube.com/watch?v=Pfd8OUP...(Not working as expected?)

[doodle68 in reply to Hidden]

I agree Mike I prefer to take Dr Gupas opion on this rather that that of anyone else until something different is proved...

[Hidden]

Not sure that anyone knows, but ignore the information around the Trial they did in Mexico, it was done with the old version of the drug and a very high dose so it can be ignored. Also remember that it is also out of patent, so anyone can make it without incurring a high cost. Lot of companies are working on new drugs where a patent exists.

[tcpace in reply to Hidden]

Interesting - do you have a source for the Mexican trial please?

[Hidden in reply to tcpace]

Sorry it was Brazil dailymail.co.uk/health/arti...

[CDreamer]

I have to avoid all Quine type drugs because of my Myasthenia - has very weird affects on me as I found out when I accidentally drank a tonic water a few years ago.

Having said that - if you have COVID & it’s thought it will be life threatening & it’s your only available treatment option - would I really refuse it because I was frightened of developing long QT - dangerous as I know that is?

Bit of Devil or Deep Blue Sea.

[Auriculaire in reply to CDreamer]

Quinolone and fluoroquinolone antibiotics also have prolongation of QT interval as a class side effect. They are closely related chemically to chloroquine as the first quinolone Nalidixic acid was discovered as a contaminant in a batch of chloroquine. Chloroquine was not used for a long time after synthesis as it was considered too toxic for humans. It was only with the advent WW2 and the depradations caused by malaria among the troops particaularly in the East that suddenly it became "ok". There are a whole raft of other nasty side effects as well as the arrythmias.

[CDreamer in reply to Auriculaire]

There are a lot of antibiotics I can’t have as well.

[5195]

Dr Sanjay Gupta has just released a video about this - you can watch it on You Tube (York Cardiology)

[Palpman]

This post should rather read: Are you at risk of sudden death from TdP by taking Hydroxychloroquine together with another QT lengthening drug such as antiarrhythmics .

Most antiarrhythmic drugs such as Flecainide increases the cQT interval but not by a dangerous amount. Over 440ms is stretching it and over 500ms you will be considered a candidate for torsades de pointes.

Flecainide alone would not push the cQT to near 500ms but if taken with any other drug that increases the interval then it may just do that.

I had to stop taking Sertraline with my Flecainide as my cQT stretched to 470ms.

It is very difficult to monitor people that die from TdP except for intentional Flecainide overdoses in suicide cases. So taking Flecainide alone at 100 x 2 pd would not have any serious problems.

EDIT: Recent studies have shown that the JT interval is a more reliable indicator for TdP episodes over cQT and this should be used going forward.

The drugs mentioned here widen the QRS wave but have less effect on the JT interval.

My cQT is 470ms and this is more than the max of 440ms and makes me a member of the LQTS club.

My JT is 350ms and this is ok so excludes me from being a candidate for TdP.