Some non-medical quack science (Corona Virus): hydrochloroquin

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    • #144125
      Max
      Keymaster

        I am seeing on the news that the old school anti-malarial drug hydrochloroquine is showing as effective to reduce viral load / aid recovery from Corona virus. As you know, I’m not a Doctor.

        However, this reminded me of some ‘old-lore’ that is sitting in the back of my mind.

        “Chloroquine is a synthetic form of quinine, a compound found in the bark of cinchona trees native to Peru and used for centuries to treat …”

        Back in the day, quinine used to be the anti-malarial drug of choice. In the ‘colonies’ (not the American ones, but places like Malaya, Africa etc) the drink of choice was gin and tonic. Why? Because tonic water was developed containing quinine, which is why it has that disinctive bitter taste.

        I don’t know how much quinine tonic water still has in it. But I believe it still has it. I also don’t know how much gin & tonic you would have to drink to cure yourself from Corona! Worth a try though!

        It would be interesting to known what sources of quinine or chloroquine are available?

      • #144130
        riflemaniv
        Participant

          Seagrams still puts quinine in their tonic. Unfortunately I’m out of gin so vodka and tonic will have to suffice.

        • #144135
          DuaneH
          Participant

            Pharmacies still have hydroxycholoroquine but they are starting to run out at the local level. I had three patients yesterday call and say their pharmacy was out. My response was for them to call around and find out which one had it in order to send the rx there.

            So the info on chloroquine’s effectiveness in vitro on coronavirii goes back to the 2003 SARS epidemic which was a corona virus. Naturally last year in China they dug up this research and began using it in vivo with positive results.

            In the middle of February I tried to track down some chloroquine. While it fell out of favor when hydroxychloroquine (which is stronger and safer) it has been having a resurgence as some malaria strains are resistant to hydroxychloroquine in the past 20 years. I had interesting conversations with pharmacies and basically in the middle of February I heard words like “sequestered” and “allocated” in regards to chloroquine. So the powers that be were already looking in that direction.

            The in vitro studies with hydroxychloroquine were even more encouraging as it is stronger in that it has a higher intracellular concentration vs chloroquine. Currently China and several of the EU countries are trialing hydroxychloroquine (plaquenil) in Covid19 and preliminary results looks good.

            NOTHING I JUST SAID OR WILL SAY CONSTITUTES MEDICAL ADVICE AND YOU ASSUME ALL RESPONSIBILITY IF YOU DECIDE TO ACT ON IT.

            BLUF: If you don’t already have your hydroxychloroquine you are behind the curve.

            • This reply was modified 4 months, 2 weeks ago by DuaneH.
          • #144137
            DuaneH
            Participant

              Dr Google says that tonic water has UP TO 83mg of quinine per liter.

              • #144138
                Max
                Keymaster

                  So, you drink a liter of tonic water getting UP TO 83mg of quinine. How does that stack up numerical wise?

                  (How much gin to mix it with?) B-)

                  You heard about the run on tonic water here first guys!

              • #144141
                DuaneH
                Participant

                  There is no approved corona virus chloroquine or hydroxychloroquine dosing regimen, but in the trials that maximum amount that I have seen is 200mg hydroxychloroquine, three times a day for ten days. As far as extrapolating a dose of quinine (which has not been trialed) towards a dose for corona dosing, I wouldn’t care to comment keeping in mind that hydroxychloroquine is far more potent in terms of pharmacodynamics.

                  I will say that quinine sulfate used to be given for leg cramps until it was pulled by the FDA 20 years ago and you can look up the dosage for that. Just keep in mind that Quinine SO4 does not translate mg-mg for base quinine.

                  • This reply was modified 4 months, 2 weeks ago by DuaneH.
                • #144143
                  wheelsee
                  Participant

                    While we may not know WHY a medication works, the fact that it does does not negate the use of it.

                    SEVERAL of our common medications, we STILL don’t know the true mechanism of action (MOA). Think muscle relaxers. Look them up – the old PDR (Physician Desk Reference) literally states for Flexeril under MOA “Unsure”

                    Plaquenil (trade name for hydroxycholoquine) is also used for rheumatoid arthritis and lupus. If you check the MOA, Medscape specifically states “unknown.” My best guess is that it has a potent anti-inflammatory property.

                    Azithromycin (Zithromax, Z-pak) has also “shown” some promise in non-randomized tests. Why? Does a specific antibiotic now work against viruses?? Nope. The vast majority of people seen for a sinus infection (within the first 3-5 days) demand a Z-pak, “its the only thing that works.” If you read the Academy of Allergy, Asthma, & Immunology guidelines for sinusitis (2014), viral sinusitis is what is happening for the first 5-7 days with bacterial being a secondary (afterwards) – with NO antibiotics recommended in those first 5-7 days. If you read New England Journal of Medicine (Feb 2012), you’ll find that Augmentin (NOT Amoxicillin which many still prescribe) is the initial treatment choice. So why Z-pak?? Because it has a POTENT anti-inflammatory property.

                    You may have also seen the use on indomethacin (Indocin) – most commonly used in gout. Another medicine with a POTENT anti-inflammatory property.

                    BLUF – while medicine is based on science, the practice of it is an art. If a medicine works (without bad side effects), we don’t ALWAYS have to understand how it works to use it.

                    Caveat – echoing Duane, NOT to be construed as medical advice

                  • #144144
                    wheelsee
                    Participant

                      For those contemplating drinking your dose – yes, yes, check with your doctor first as one of the potential BAD side effects is prolonging the QT interval (on your EKG). SOOOO, what does that mean?? bad rhythms like Torsades which can be lethal (if progresses).

                      The primary reason quinine was pulled for leg cramps was because of “unpredictable serious and life-threatening hematologic reactions”.

                      Quinine also stimulates release of insulin from the pancreas, so low blood sugars….killing off brain cells.

                      ALL of the above can be found on various medical websites. Medscape is the one I use for work.

                    • #144145
                      DuaneH
                      Participant

                        Along those lines of warning. If you take too much of the quinines at one time you risk retinopathy.
                        Anecdotally: I worked at a cash clinic. 50% of the patients were from south of the border where many (if not all) medicines are available over the counter. A large percentage of them were permanently F’ed up from self medicating or being medicated on advice from the pharmacist.

                        • This reply was modified 4 months, 2 weeks ago by DuaneH.
                      • #144147
                        wheelsee
                        Participant

                          A large percentage of them were permanently F’ed up from self medicating or being medicated on advice from the pharmacist.

                          ^^^^^^^ THIS.

                          Failure to heed keeps people like Duane, Mark, and myself in business :bye:

                        • #144148
                          DuaneH
                          Participant

                            In case it wasn’t clear from my postings since I did not explicitly state it, the purpose of my posting was to present the factual (at least as I see it) information as most information that abounds on the internet is third or 4th hand and not from anybody medical. It was also to impress upon anyone reading this thread the necessity of not going and doing anything stupid and the necessity of seeking medical advice.

                            (a friend of mine called me up yesterday wanting to know what to take for diarrhea. the cause? he had been taking 4 tablespoons of concentrated tonic water syrup (extract) a day that he picked up in India last year “you know the kind with real cinchona tree extract” based on Elon Musk’s tweet. I told him I was going to bill him not for the medical advice, but for his stupidity. Unfortunately I couldn’t find and ICD-10 code to bill with.)

                          • #144149
                            Hessian
                            Participant

                            • #144150
                              wheelsee
                              Participant

                                Unfortunately I couldn’t find and ICD-10 code to bill with.)

                                Try F73 (though it does list as “congenital”, I’ll leave that determination to you)

                                • This reply was modified 4 months, 2 weeks ago by wheelsee.
                              • #144152
                                DuaneH
                                Participant

                                  Unfortunately I couldn’t find and ICD-10 code to bill with.)

                                  Try F73 (though it does list as “congenital”, I’ll leave that assess to you)

                                  Can’t bill for it. I have used it to justify a 25 minute counseling session to raise the visit to 99214. It would seem that I can’t fix stupid, but I can diagnosis (just can’t get paid for it).

                                • #144155
                                  Max
                                  Keymaster

                                    Currently in WalMart. No TP. We actually need TP for normal use. Fuckers.

                                    Anyway, didn’t buy any tonic water. Will drunk the gin neat. Had no idea Elon Musk stole my ideas and was talking about this….. :unsure:

                                  • #144156
                                    DuaneH
                                    Participant

                                      Currently in WalMart. No TP. We actually need TP for normal use. Fuckers.

                                      Anyway, didn’t buy any tonic water. Will drunk the gin neat. Had no idea Elon Musk stole my ideas and was talking about this….. :unsure:

                                      Apparently he tweeted about it Monday night and on Tuesday is when I began getting phone calls from patients wanting refills. Ironically the physician in the office didn’t begin taking me seriously until Elon tweeted about it (he drives a Tesla).

                                    • #144161
                                      trailman
                                      Participant

                                        Just an FYI

                                        Israeli pharmaceutical company Teva is donating millions of doses of a malaria drug that is believed to be effective in fighting the symptoms of the coronavirus.

                                        The Jerusalem Post reports that the six million doses of hydroxychloroquine sulfate will be shipped to US hospitals started March 31. By the end of next month, 10 million will be shipped.

                                        It is uncertain how effective the malaria treatment will be against coronavirus, but research is currently ongoing.

                                        Brendan O’Grady, Teva Executive Vice President, North America Commercial, said, “We are committed to helping to supply as many tablets as possible as demand for this treatment accelerates at no cost.”

                                        “Immediately upon learning of the potential benefit of hydroxychloroquine, Teva began to assess supply and to urgently acquire additional ingredients to make more product while arranging for all of what we had to be distributed immediately,” he stated.

                                      • #144162
                                        trailman
                                        Participant

                                          Why TF can’t i ever edit my posts, its a random issue

                                        • #144167
                                          LittleBigBill
                                          Participant

                                            Well, I’ll cherish the few bottles of tonic water I still have, but the gin is good with a little vermouth…. :good: :yahoo:

                                          • #144288
                                            DuaneH
                                            Participant

                                              Apparently the shortage of chloroquine and hydroxycloroquine is official now. As far as I can tell, hospitals are adequately supplied and the few friends I have that work in hospitals are telling me they are using it in certain cases.

                                            • #144311
                                              wheelsee
                                              Participant

                                                Some more information from one of my attendings (Board-certified in Internal Medicine and Cardiology)

                                                A POSSIBLE ROLE FOR SINGLE DOSE HYDROXYCHLOROQUINE FOR PREVENTION OF LETHAL CORONAVIRUS INFECTION

                                              • #144352
                                                Joe (G.W.N.S.)
                                                Moderator

                                                  Apparently the shortage of chloroquine and hydroxycloroquine is official now.

                                                  This should help, but I am uncertain of what will actually be required.

                                                  Israel’s Teva Donates 6 Million Doses of Malaria Drug to Fight Coronavirus

                                                  Excerpt:

                                                  Teva Pharmaceutical Industries, Israel’s leading drug producer, announced Thursday that it is donating six million doses of its malaria tablet to the United States as testimonies continue to roll in claiming that it could potentially treat people with the Chinese coronavirus.

                                                  Teva said it will ship the hydroxychloroquine tablets via wholesalers to hospitals across the country by March 31 and provide over ten million within a month.

                                                  “We are committed to helping to supply as many tablets as possible as demand for this treatment accelerates at no cost,” Teva executive vice president Brendan O’Grady said in a statement.

                                                • #144402
                                                  DuaneH
                                                  Participant

                                                    Lots of companies manufacture it or have the ability to mass produce it. I suspect the shortage will be short lived. Maybe another 2 weeks. I could not find the manufacturing process for it, so I don’t know how long it takes to manufacture or what the precursors are. It is just a pain in the ass for my patients when did not plan ahead.

                                                  • #144294
                                                    trailman
                                                    Participant

                                                      Apparently the shortage of chloroquine and hydroxycloroquine is official now. As far as I can tell, hospitals are adequately supplied and the few friends I have that work in hospitals are telling me they are using it in certain cases.

                                                      OK I’ll bite. How can you have an official shortage yet be adequately supplied. And define shortage. Bayer just gave the government 3 million doses. Plus another six million in ten days from Teva.

                                                      https://www.reuters.com/article/us-health-coronavirus-bayer/bayer-donates-three-million-malaria-tablets-to-us-for-potential-use-against-coronavirus-idUSKBN21637E

                                                      https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

                                                      As of yesterday there are 15,219 cases in the US, that’s just positive tests not symptomatic. Even by that math that’s about 180 doses per positive test person in the supply chain moving not to include whats in stock.

                                                      There are 5,564 registered hospitals in the U.S., according to the American Hospital Association. This statistic includes federal hospitals, long-term care hospitals, psychiatric hospitals, institutions for the mentally disabled and alcohol and other chemical dependency rehabilitation hospitals.

                                                      Not every one is treating patients. So that’s 540 doses for each hospital assuming its distributed evenly though ALL hospitals.

                                                    • #144434
                                                      wheelsee
                                                      Participant

                                                        Per 2 different pharmacists (same chain), the TX board of pharmacy released a statement Friday (3/20) advising pharmacists to NOT fill prescriptions for Plaquenil for off-label uses. (FYI – in TX, every prescription HAS to have an appropriate diagnosis attached).

                                                      • #144465
                                                        DuaneH
                                                        Participant

                                                          It is a shortage when the local pharmacies do not have the medicine and sold out in less than a week’s time and the one’s that do have it are only dispensing it 2 weeks at a time for lupus and RA patients.

                                                          I doubt the bayer and teva shipments are going into the free market pipeline yet.

                                                        • #144210
                                                          Eric
                                                          Participant

                                                            Do some reading on a compound called Quercetin….

                                                            it is the main active ingredient in Black Elderberries.

                                                            Basically Quercetin has been shown in-vivo and in-vitro to disable the virus’ ability to attach, and replicate. I started on it when the first case presented in the US @1500mg a day, combined with Vitamin C, Vitamin D, Selenium, Magnesium, and Zinc.

                                                            Vitamin C taken with Quercetin helps it retain it’s chemical structure, fat, magnesium, and sugar help with absorption.

                                                            This is purely Antecdotal, so take it for what it is.

                                                            Right after I started taking this stuff, back in early February, my wife and I took our youngest son and one of his friends to a local indoor entertainment park for his birthday.

                                                            A week later, my wife started waking up with a sore throat. that went on for about four days, and on the fifth day she woke up with her lings hurting, bad cough, general malaise, and no energy.

                                                            I never got it. I felt like I was going to. for two days I had a sore throat, and the third day I could feel it in my chest very mildly, but that is as far as it went. It never developed any further, and within 3 days I was clear. She much better, but is still not completely over it. The thing is that I usually get every respiratory infection that comes around. Under normal conditions, I would still be sick with it, but I never got sick with it to begin with.

                                                            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4728566/

                                                            https://www.longdom.org/open-access/quercetin-a-promising-treatment-for-the-common-cold-2329-8731.1000111.pdf

                                                            Recent in vitro studies have demonstrated that quercetin acts as a
                                                            potent antiviral agent by inhibiting viral replication of several
                                                            respiratory viruses, including influenza virus, parainfluenza virus,
                                                            respiratory syncytial virus, adenovirus, and rhinovirus [18,20-23].
                                                            Although the quercetin’s antiviral mechanisms are not well
                                                            understood, a number of possibilities have been proposed and is
                                                            summarized in (Figure 1)

                                                            Figure 1: Quercetin inhibits viral replication at various stages:
                                                            blocks endocytosis via inhibition of PI-3 kinase, transcription of
                                                            viral genome by inhibiting RNA polymerase 3D POL and viral
                                                            protein translation by promoting cleavage of eIF4G. At the same
                                                            time quercetin also increases viral clearance by enhancing
                                                            mitochondrial antiviral responses. All these events together lead to
                                                            reduced pro-inflammatory responses.
                                                            Quercetin increases skeletal muscle mitochondrial biogenesis, and
                                                            so could exert its antiviral effects through enhanced mitochondrial
                                                            antiviral signaling [24]. Quercetin has been shown to inhibit PI-3-
                                                            kinase, an enzyme required for viral endocytosis, and RNA polymerase
                                                            3DPOL which is required for negative-strand RNA production.
                                                            Finally, there is also evidence that quercetin cleaves eIF4G to inhibit
                                                            viral genome translation, and may inhibit PI-4-kinases required for
                                                            viral replication in specialized lipid organelles of the cell [24].
                                                            Additionally, quercetin reduces rhinovirus-induced expression of
                                                            pro-inflammatory cytokines and lung inflammation in mice [23,24].
                                                            Quercetin was also found to reduce viral load and improve lung
                                                            function in a mouse model of chronic obstructive pulmonary disease
                                                            [24]. Interestingly, quercetin supplementation was demonstrated to
                                                            reduce susceptibility to influenza A virus infection and the severity of
                                                            the disease in mice [25], and reduce symptoms of upper respiratory
                                                            infections in athletes post- stressful exercise [26]. Despite mounting
                                                            evidence, no clinical trials have been performed examining the effects
                                                            on the common cold.

                                                            There is also news out of China that TCM (Traditional Chinese Medicine) has been shown effective as well.

                                                            https://www.thailandmedical.news/news/must-read-china-s-secret-to-controlling-the-covid-19-outbreak-is-traditional-chinese-medicine-concoctions-used-alone-or-in-conjunction-with-antiviral-?fbclid=IwAR1bIkhHeataXn0kS7Ph45GDuZHsdL4bw-h_1h3WWBTG9WwwFZQTLU7VLT0

                                                          • #144464
                                                            DuaneH
                                                            Participant

                                                              It is a shortage when the local pharmacies do not have the medicine and the online pharmacies are sold out. My local Publix pharmacy that I am on good terms with the pharmacist told me the direction that Publix has is that they do have some and are shipping it from their central supply (or whatever) but they are only to dispense 2 weeks at a time. I don’t think that bayer and teva’s donations have made it into the pipeline.

                                                              And then I question which pipeline they are going to. I doubt they will go directly to the free market pharmacies. At least yet. First priority will be hospitals.

                                                              Like I said, as of last week I had patients who couldn’t find any when they went to get their refills.

                                                              Apparently the shortage of chloroquine and hydroxycloroquine is official now. As far as I can tell, hospitals are adequately supplied and the few friends I have that work in hospitals are telling me they are using it in certain cases.

                                                              OK I’ll bite. How can you have an official shortage yet be adequately supplied. And define shortage. Bayer just gave the government 3 million doses. Plus another six million in ten days from Teva.

                                                              https://www.reuters.com/article/us-health-coronavirus-bayer/bayer-donates-three-million-malaria-tablets-to-us-for-potential-use-against-coronavirus-idUSKBN21637E

                                                              https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

                                                              As of yesterday there are 15,219 cases in the US, that’s just positive tests not symptomatic. Even by that math that’s about 180 doses per positive test person in the supply chain moving not to include whats in stock.

                                                              There are 5,564 registered hospitals in the U.S., according to the American Hospital Association. This statistic includes federal hospitals, long-term care hospitals, psychiatric hospitals, institutions for the mentally disabled and alcohol and other chemical dependency rehabilitation hospitals.

                                                              Not every one is treating patients. So that’s 540 doses for each hospital assuming its distributed evenly though ALL hospitals.

                                                            • #145397
                                                              wheelsee
                                                              Participant

                                                                Looks like there may be something to using an anti-malarial drug.

                                                                From what I’m seeing, the COVID19 seems to be blowing apart the heme part of hemoglobin, thereby causing patients to not oxygenate normally. While we assumed this was a respiratory disease, this may only be the symptom.

                                                                Hydroxychloroquinolone (trade name Plaquenil) is as Max stated, an anti-malarial drug. The malaria parasite Plasmodium falciparum uses host erythrocyte hemoglobin as a major nutrient source. So maybe there’s something to this use of Plaquenil after all.

                                                                Full disclosure – I am now part of a study at our facility that is HYDROXYCHLOROQUINE PRE-EXPOSURE PROPHYLAXIS STUDY. I’ve asked to be part of the treatment arm – which involves “Loading dose is 400mg BID on day 1, followed by 400mg QD once weekly, taken with food. This is similar to the dosing schedule for malaria prevention.”

                                                              • #145534
                                                                tahawus
                                                                Participant
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