By Tom Rosenthal
Self-medication by a Phoenix-area couple in their 60s with chloroquine phosphate in the mistaken belief the additive, commonly used by aquariums to clean fish tanks, was a prophylactic for COVID-19 resulted in the husband’s death and his spouse in critical care, according to officials.

Within 30 minutes of taking chloroquine phosphate, the couple began suffering side effects that required admission to a nearby Banner Health hospital, said officials at the acute care center.

Daniel E. Brooks, MD, the medical director of the Banner Poison and Drug Information Center, said the hospital was informed the couple took “at least a couple of days’ worth of normal dosing” of chloroquine phosphate as a preventive agent against COVID-19.

The antimalarial drug chloroquine, which was originally approved in the 1940s and is also used to treat lupus and rheumatoid arthritis, along with the safer, more frequently used version, hydroxychloroquine, are being used to treat severe symptoms of COVID-19, but are not being used as COVID-19 prophylaxis.

The desire to prevent COVID-19 is understandable, and many people are frightened by news reports they are hearing, explained P. Brandon Bookstaver, PharmD, FCCP, FIDSA, BCPS, an infectious diseases pharmacist at Prisma Health Midlands, in Richland, S.C. 

Pharmaceuticals intended for fish are easy to obtain online, and many people mistakenly believe they are FDA-approved drugs that can be used by people, too.

“These medications, including chloroquine, are associated with significant side effects including serious cardiac events. They are not FDA approved and are intended for fish only, and should never be used in humans,” said Dr. Bookstaver, who also is an associate professor at the University of South Carolina College of Pharmacy, in Columbia.

No COVID-19 Prophylaxis

“These online purchases of fish medications may be driven by fear, uncertainty of available treatments or diagnostics, and a desire to medicate while in self-isolation,” said Dr. Bookstaver, who added that people using any of these drugs for prevention is “concerning” because there are no data that they prevent COVID-19, and they should be saved for those who really need them.

In fact, most people with COVID-19 don’t need chloroquine. “From what we know right now, approximately 85% of patients who test positive for COVID-19 will do well and make a complete recovery without any specific medications or treatment,” Dr. Brooks said.

“Most patients who become infected with COVID-19 will only require symptomatic care and self-isolation to prevent the risk of infecting others,” Dr. Brooks said. “The routine use of specific treatments, including medications described as ‘anti?COVID-19,’ is not recommended for nonhospitalized patients, including the antimalarial drug chloroquine.”

Dr. Brooks urged the medical community not to prescribe this medication to any nonhospitalized patients.

In a joint letter, the Lupus Foundation of America, American College of Rheumatology, American Academy of Dermatology, and the Arthritis Foundation told the White House Coronavirus Task Force that the increased demand for hydroxychloroquine and chloroquine “has exacerbated their already limited availability for patients who rely on them to meet their medical needs.”

In their letter to Vice President Mike Pence, the organizations said: “Therefore, we urge you to work with us and the broader health care community to help ensure continued availability of these drugs for the patients who are maintained on them to avoid disability, illness and even early death.”

Although clinical trials have not verified either antimalarial drug’s effectiveness as a treatment for COVID-19, in his press conference on Monday, President Donald Trump said, “It could be a game changer” for COVID-19.

Hospital Supply Issues

The couple might have turned to the fish product because they couldn’t get the drugs indicated for human consumption. They weren’t the only ones; hospitals are having a difficult time obtaining these medications, too.

The supply of chloroquine and hydroxychloroquine is not keeping up with demand, according to Vizient Inc., an Irving, Texas-based health care performance company. “We have seen 6,842% and 2,196% increase in orders by Vizient members for chloroquine and hydroxychloroquine, respectively, since the World Health Organization declared COVID-19 a pandemic,” said Dan Kistner, the group senior vice president for pharmacy solutions at Vizient. He added that rates to fill orders for chloroquine and hydroxychloroquine are dropping to as low as 1.4% and 12.1%.

Vizient called on the White House Coronavirus Task Force and the FDA to redirect the supply of these drugs from retail pharmacies to hospitals and acute care institutions that have patients with COVID-19.