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Comment by ggm | Hacker News Reader

This is an increadibly potent drug with serious side effects according to anything I read, its not first-line treatment its last-line, when everything else fails. You can go blind, irreversibly.

Please people, speak to trained medical people before reaching to the drug cabinet.

I am not a doctor. This advice is not meant to contradict the rule of only taking medical advice from medical professionals.

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From wikipedia.

One of the most serious side effects is a toxicity in the eye (generally with chronic use).[11] People taking 400 mg of hydroxychloroquine or less per day generally have a negligible risk of macular toxicity, whereas the risk begins to go up when a person takes the medication over 5 years or has a cumulative dose of more than 1000 grams. The daily safe maximum dose for eye toxicity can be computed from one's height and weight using this calculator. Cumulative doses can also be calculated from this calculator. Macular toxicity is related to the total cumulative dose rather than the daily dose. Regular eye screening, even in the absence of visual symptoms, is recommended to begin when either of these risk factors occurs.[12]

> ... has a cumulative dose of more than 1000 grams. ...

woowza a Kg worth of drug !!! this doesn't look correct to me !

People taking 400 mg of hydroxychloroquine or less per day generally have a negligible risk of macular toxicity

400mg/day for 5 years is 730 grams.

only if everything gets stored, and there is no chance for that

The risk is for cumulative (not accumulated) dose:

has a cumulative dose of more than 1000 grams

And the calculator they link out to gives the same number I calculated.

A kg isn't necessarily that much over a lifetime. I'm over that with at least one drug.

This drug accumulates in various tissues, so for retinopathy what matters is the cumulative amount of the drug consumed over time.

oh man ! just like excess of vitamin-d can lead to vitamin-d toxicity, so can this. in my naïveté, i was assuming that excess of it would be just flushed out.

Its concentration in lung can be 100 times or more of that in serum. This may be helpful for its efficacy against the virus.

taken over the years

The retinopathy happens only after years of use (like a decade). Also, as an immunosuppressant, it is pretty slow acting in that it takes two three months to even start working. The currently prescribed dosage for the viral infection is for 5-10 days (albeit at slightly higher dosage than used for malaria/lupus etc.).

Growing up in Kenya in the 80s, it was common to take chloroquine as an anti-malarial medicine. I took it several times and the same applied to almost every other person I knew. Other than being a very bitter medicine, I do not remember any other side effects. This was commonly prescribed and available over the counter. However, in the 90s, doctors started encouraging people to take newer anti-malarial medicines because the of drug resistance of the malaria parasites. However,I know of only one person who ever got blind from taking anti-malarial medicine and that was not exactly chloroquine but quinine. There are differences between the two. As per the Wikipedia page, chloroquine is considered a safe and essential medicine by the WHO.

I realise even quinine is in the list of essential medicines and also considered safe by the WHO.

There is a lot of stuff on this list that is definitely not "safe": for example, morphine, atropine.

You can just buy it over-the-counter in some countries, right? How dangerous can it really be? Follow the instructions on the box like citizens of those countries do.

IMO we in the US need to take the coronavirus as a wake up call to stop ignoring the medical systems of other countries and admit that they might have something to teach us. We shouldn’t just assume the American medical system is always the best one.

How dangerous is random medical advice from an internet forum? Over the counter drugs can potentially kill people, too, if used improperly.

When I was on hypertension meds, I was on S1 scheduled meds which required a script (in Australia). I visited an Asian city and bought them over the counter without a script.

These medicines are not something you should take if you do not need them. "how dangerous can it really be" is pretty much why rule one exists. Not the least of which is, antibiotics are available over-the-counter in some countries, and this contributes to why antibiotics are not as potent as they used to be.

The US medical system is only great to those that don't have to go through great struggles to afford it. It is the worlds worst and most dystopian to everyone else (the majority).

Financial status deciding who gets health care is the ultimate death panel.

The US health care system is awful in all ways.

> You can just buy it over-the-counter in some countries, right? How dangerous can it really be?

That's absolutely meaningless, some countries are nuts. Just about anything gets sold over the counter somewhere. There's even countries where guns are sold over the counter.

What kind insane countries could that be? Sounds like a black mirror episode ;-)

Given that governments of these countries are actually doing something in response, covid-19 must be way more dangerous than guns. Oh.

The UK has it otc

You can buy all kinds of super dangerous stuff in the cleaning aisle of your average supermarket. General availability is no indicator of toxicity. Ok, those are not made for ingestion. But even ignoring that factor you could list alcohol, tobacco and 30 different items from the grab-for-yourself stand at the local supermarket. You could likely kill yourself with just a handful of tablets from there if you knew what you were doing.

This seems a legit argument in 1000 years by a historian who wanted to logic why drugs clearly couldn't have needed prescriptions.

I was pretty excited when I realized you can buy fairly pure, concentrated sulfuric acid in the cleaning isle at Walmart. Nothing cleans dirty glassware quite like it! Accidentally got a stopper stuck in a flask? No problem, add some H2SO4 and just pour the stopper out a few days later.

Restricting what people can buy because they might hurt themselves with it doesn’t work (because everything can be misused) and only creates problems because sometimes restricted things turn out to be really important.

The therapeutic window for chloroquine is small, and there are very adverse side-effects if overdosed (heart arrythmias being the most dramatic I guess but macular toxicity is not something you'd want to risk either). I actually heard a story on that's how they dosed it "back in the days" - the sailors took it until they fainted our of various heart arrythmias and then they knew they had to back down a bit next time..

To the plus side, its cheap. So, absent drug companies motivations to make cheap drugs (low) it is affordable at scale, and if it turned out to be useful e.g. early in the stage of the disease, this might be very good for wild infections. Or, maybe it points to drugs which are safer, equally cheap, and able to be made with less side effects.

(see rule one: this is not medical advice)

Cheapish - as I recall about $300 for 90-day supply of generic hydroxychloroquine if paying cash in US. I mean, not cancer drug spends but if you are on it for life it’s an annoying annual expense.

US drug prices are pretty crazy. A random search in an internet pharmacy shows 100 tablets of 200mg hydroxychloroquine is like 30€ in Germany.

Quinine course used to cost around 1.5 RMBs in 1998.

Managed to catch malaria in Hebei out of all places, during my first trips to China with my father.

Indeed. Another example: https://twitter.com/jawj/status/1199026735980990465

I believe its around $30 in the US at Ralphs or Costco

It is, but in recent years it was much higher because of "shortages" (actually just lack of competition after one of the main suppliers got busted by USDA for poor quality control).

For Kenya, it works out as 0.3 USD/tablet for HCQS

Right, the only medication I sometimes bring from the US now is acetaminophen/paracetamol because it's the only one I've found that's much cheaper there. The rest are probably cheaper in Germany so I would just go there if I needed them.

For regulatory reasons, US drug list prices are completely detached from the actual price you end up paying (assuming you do a bit of research). See e.g. https://www.goodrx.com/hydroxychloroquine ($20 for 60x200mg)

I checked into this recently because a family member takes it for lupus. It's 10x to 30x more expensive in the US than everywhere else in the world.

Well, that reflects inflated American prices. In India, it is about 270 INR for 90x 200mg, or about $3.65. Non-generic hydroxychloroquine (Plaquenil) is about 3 times the price.

There are certain websites which will ship a 90-day supply for $10 plus change from India, paid with bitcoin. Just sayin'.

It has come down a lot in the past year actually. You can get a 30 day supply for an adult for like $30 for the generic brand without insurance if you shop around. I take it everyday, I don't have any side effects from it but do have to get my eyes checked annually with an expensive test.

I see this chloroquine thing all over twitter and elsewhere and I keep warning people to not take any without getting a doctor to ok it because of the side effect risk. Incredible what people will tell each other, your average griefer couldn't do much better.

I guess I don't know the doses involved, but it's not that bad on it's face. I took it as an antimalarial for a few months.

Worst part is that it gives you weird dreams that puts you into a weird, almost bad trip head space.

It's not, I've taken Hydroxy-chloriquine for years and I feel fine and my doctor has said as much. You should get an eye check yearly to make sure it's not hurting your eyes.

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