The latest talk of confusion about the use of Hydroxychloroquine for dealing with COVID-19 is well known. In order to tackle any pandemic, such as the ongoing coronavirus, it is extremely important to develop the weapon against the microbes, that is the vaccine. The development of the vaccine requires extensive research about the genetic material of the virus and how our body reacts to it and then it has to be followed up with human trials. This is a long term process of dealing with the problem in the picture, but at present, it is extremely important that we use the already existing medicines in a combination that will prove beneficial in the short-term and help us to tackle the problem head-on.

The latest drug of preference for dealing with coronavirus is Hydroxy-chloroquine along with Oseltamivir, Azithromycin and Lopinavir. These are the drugs that have been enlisted by ICMR to deal with the COVID-19 infection in India.  However,  just like protective equipment, the production of the drugs in question is disrupted due to the disproportionate chain of supply and demand.

What is Hydroxychloroquine (HCQ)?

This is the structure of Hydroxychloroquine

Hydroxychloroquine is an antimalarial drug used to treat active malaria cases in different countries. It was first approved by the FDA in 1955 and is deemed to be remarkably free of side effects. This drug works by suppressing the innate immune responses of a body to the foreign antigens and killing the parasite causing disease.

Besides its old school use for the treatment of malaria, the drug is also used for treating rheumatoid arthritis, lupus and Juvenile inflammatory arthritis.

It is not recommended in the prophylaxis of children under the age of 15. And some of the possible contraindications include known cases of retinopathy, hypersensitivity to Hydroxy-chloroquine and 4- aminoquinoline compounds. It may also cause complications in patients with heart conditions.

It is very important to not self medicate and only take the drug after the discussion and advise of the doctor.

Relation between HCQ and COVID-19

Medicine tablets for treating COVID - 19

With the outbreak of coronavirus in China, medical authorities conducted the studies on various drugs that could be used for the treatment of the infection under observation, and the studies reported Hydroxy-chloroquine to have the clinical benefit over a comparison group and hence it was added in the list of approved drugs that could help in the treatment COVID-19.

The National Task Force set up by Indian Council of Medical Research approved the use of Hydroxy-chloroquine for high-risk population which includes asymptomatic healthcare workers dealing directly or indirectly with the patients of coronavirus and asymptomatic household contacts of laboratory-confirmed cases.

The research for the use and effects of this generic drug in cases of pre and post-exposure to Sars-CoV2 and patients with mild, moderate and severe symptoms of COVID-19 is underway. The medical authorities will make the required changes in the usage of the drug based on the upcoming results.

Hydroxy-chloroquine Manufacturing and Patent

The active ingredient was first patented in 1958. However, it is declared as public property and hence the patent databases across different companies are free to be used.

India is the world’s largest producer of Hydroxy-chloroquine. But we import the raw materials needed for the production from China. Due to the ban on exports in China, India is struggling for the procurement of raw materials and this has slowed the production of the drug by pharmaceutical companies. The leading Hydroxy-chloroquine producing pharmaceutical companies in India Ipca laboratories, Zydus Cadila and Wallace pharmaceuticals.

HCQ Exports from India

The chemicals of hydroxychloroquine

Under the given circumstances, the health ministry of India restricted the sale and distribution of Hydroxy-chloroquine from 16th March 2020. It also banned the export of the drug in order to meet domestic demand. Health ministry issued a notice to the medical fraternity that the sale of preparations containing Hydroxy-chloroquine should be in accordance with the conditions listed under this schedule H1 of drugs and cosmetic rules, 1945.

This move was aimed to prevent the misuse and to meet the shortage of supply due to the limited availability of raw material from China.

The US warns India

United States of America reported a rapid upsurge in the numbers of COVID-19 cases and it is currently the worst affected country by the pandemic. The number of COVID-19 positive cases in the USA has crossed the mark of 400,000 and the Trump administration has warned of the possibility of 100,000 deaths in the coming weeks.

The US government’s order for Hydroxy-chloroquine was declined by India, in order to meet its regional demands, but the American president was not content and warned India on 6 April 2020, of possible retaliation if it did not provoke the restriction.

India reconsiders the Proposal of Hydroxychloroquine

India exports Hydroxychloroquine

After the USA’s warning of possible retaliation, India has removed the ban on the export of Hydroxy-chloroquine and other essential drugs.  Anubhav Srivastav, the spokesperson of the ministry of external affairs said, “With regards to paracetamol and Hydroxy-chloroquine, they will be kept ina licensed category and their demand position will be continuously monitored”.

He also stated that India has decided to licence paracetamol and Hydroxy-chloroquine in appropriate quantities to the neighbouring countries and the countries which are worst affected by the pandemic, in the view of humanitarian aspects. The MEA has also requested to not depoliticise the matter.

Following this announcement, the directorate general of foreign trade (DGFT) lifted the ban on the transport of 14 drugs from 6 April 2020.

Indian council of medical research place an order for hundred million tablets of Hydroxy-chloroquine to Ipca laboratories and Zydus Cadila pharmaceuticals. The national pharmaceutical association has assured that 3 firms in the country can produce 40 metric tons of Hydroxy-chloroquine together and the production can be scaled up if the demand increases further.

It is very important to know that Hydroxy-chloroquine is still under research and is a preferred drug at present used in the treatment of Coronavirus infection in combination with other drugs. It is very important to note to “ not self medicate” oneself with any drugs and to report immediately to the medical professionals in the case of any visible side effects observed. Any adverse drug reaction can be reported on helpline or app of pharmacovigilance program of India.

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