This article was correct at time of publishing (May 6). To keep up with the latest information please visit our COVID-19 hub
In recent weeks, chloroquine and hydroxychloroquine have been in the headlines, touted as potential treatments for COVID-19. As of June 16, the Medicines and Healthcare products Regulatory Agency (MHRA) has suspended recruitment to COVID-19 hydroxychloroquine trials until further data which justifies their continuation have been provided, and any additional safety measures have been implemented*.
Tesla chief executive officer Elon Musk and US president Donald Trump were the first to tweet thoughts about the efficacy of these drugs for treating COVID-19 – despite the evidence being unclear and the drugs not being licenced for the treatment of COVID-19.(1) This was then followed by the news that an Arizona man had died after he and his wife ingested fish tank cleaner containing chloroquine phosphate, although it is unclear if the couple took the chloroquine specifically as a 'precaution' against coronavirus.(2)
The European Medicines Agency (EMA) and other regulatory bodies across the world were quick to clarify that chloroquine and hydroxychloroquine are only to be used for those conditions for which they are licensed – malaria and certain autoimmune diseases, or as part of clinical trials or nationally agreed protocols.(3)
Trials under way
Researchers are exploring a variety of ways of tackling COVID-19. Clinical trials are ongoing to test chloroquine and hydroxychloroquine as possible treatments, or to prevent COVID-19 infection.(4)
MHRA guidance advises that because these clinical trials are currently underway there is no “clear, definitive evidence that these treatments are safe and effective for the treatment of COVID-19” and therefore “they should only be used for this purpose within a clinical trial”.(4)
The Royal Pharmaceutical Society (RPS) also advises against the use of chloroquine and hydroxychloroquine to treat COVID-19: “Without access to controlled clinical data, a fully informed assessment on the safety and efficacy profile of chloroquine and hydroxychloroquine in treating COVID-19 cannot be made”. It also advises they will monitor ongoing clinical trials for new evidence.(5)
Private prescriptions and direct requests
The National Pharmacy Association (NPA) has been informed of pharmacies receiving requests for over-the-counter (OTC) sales of chloroquine for preventing or treating COVID-19 infection, as well as doctors and other prescribers prescribing chloroquine and hydroxychloroquine for personal use or for friends/family with the intention of preventing or treating COVID-19 infection”.(6)
The NPA has released advice to pharmacists and pharmacy teams receiving these requests or prescriptions:
- Not to sell/supply any chloroquine OTC for preventing/treating COVID-19 infection.
- Be cautious of any requests for OTC chloroquine; in the current pandemic situation, it is unlikely that OTC requests for chloroquine will be for malaria prophylaxis/travel purposes.
- Not to sell/supply chloroquine OTC to themselves for personal use or for friends or family for preventing/treating COVID-19 infection.
- Not to prescribe chloroquine or hydroxychloroquine (if you are an independent pharmacist prescriber) for your personal use, or for friends or family for preventing/treating COVID-19 infection.
- Not to dispense prescriptions for chloroquine or hydroxychloroquine intended for preventing/treating COVID-19 infection.(6)
The NPA also warns its professional indemnity insurance will not cover:
- OTC sales or supplies of chloroquine intended to be used for prevention/treatment of COVID-19 infection.
- Dispensing of prescriptions for supply of chloroquine and hydroxychloroquine prescribed for prevention/treatment of COVID-19 infection.(6)
The RPS has also issued advice that community pharmacy has “no contractual obligation to dispense private prescriptions” and advises pharmacists to use their professional judgment. If they believe a private prescription is clinically inappropriate, they can refuse to make the supply.(7)
The RPS has advised pharmacists, as with all professional decisions, to explain their reasoning for refusal to the patient and prescriber and to make appropriate records.
The society recommends reading its ‘Ethical, professional decision making in the COVID-19 pandemic’ guidance to assist with making difficult decisions and ensure safe and effective care as well as its guidance on making professional decisions.(8,9) The society says it will back pharmacists using their “professional judgement in situations such as this”.(7)
Chloroquine and hydroxychloroquine are vital medicines for those who need them. Their use should be restricted to authorised indications and stockpiling discouraged.
The RPS says it has received “anecdotal reports that people with psoriasis are finding it hard to get hold of hydroxychloroquine” and the EMA has advised healthcare professionals not to write prescriptions that cover more than the usual duration and that patients only receive their usual supply in order to prevent unnecessary strain on supply chains.(3,7)
In addition, the Department of Health and Social Care has added all strengths and forms of chloroquine phosphate and hydroxychloroquine to the list of products banned from parallel export in order to tackle shortages.(10)
Advice to customers
Pharmacists are in an ideal position to provide clarity to customers around the claims surrounding these treatments for COVID-19. It is vital that your customers are not tempted to self-treat with chloroquine or hydroxychloroquine and are advised that these medicines should only be used if they have been prescribed for a licensed use.
Advise customers that both chloroquine and hydroxychloroquine can have serious side effects when used inappropriately, especially at high dose or when used in combination with some other medicines. Encourage customers to continue to talk to you, or their GP, if they have any questions about the use of chloroquine or hydroxychloroquine or other medicines.(3)
Further information can be found on the C+D coronavirus hub.
*Article amended on June 18 to reflect MHRA's suspension of recruitment to COVID-19 hydroxychloroquine trials
- Washington Post (April 2020) The rise and fall of Trump’s obsession with hydroxychloroquine.
- The Guardian (March 2020) Arizona man dies after attempting to take Trump coronavirus 'cure'.
- European Medicines Agency (April 2020) COVID-19: chloroquine and hydroxychloroquine only to be used in clinical trials or emergency use programmes.
- Medicines and Healthcare Products Regulatory Agency (March 2020) Chloroquine and hydroxychloroquine not licensed for coronavirus (COVID-19) treatment.
- Royal Pharmaceutical Society (2020) COVID-19 Practical guidance and FAQs: Can chloroquine or hydroxychloroquine be used as an antiviral treatment of COVID-19?
- National Pharmacy Association (March 2020) COVID-19: Chloroquine and hydroxychloroquine.
- Royal Pharmaceutical Society (2020) COVID-19: Practical guidance and FAQs: I have received a private prescription for hydroxychloroquine to treat COVID-19, what's the advice around this and should I dispense it?
- Royal Pharmaceutical Society (April 2020) RPS Guidance on ethical, professional decision making in the COVID-19 Pandemic.
- Royal Pharmaceutical Society (2020) COVID-19 practical guidance and FAQs.
- Medicines and Healthcare Regulatory Agency: Department of Health and Social Care (April 2020) List of medicines that cannot be exported from the UK or hoarded.