Australian doctors and dentists have been told to stop prescribing a rarely used antimalarial drug to their families as a “just in case” strategy for COVID-19.

And for good reason – the drug could send them blind.

The Therapeutic Drug Administration (TGA) this week intervened to stop the practice, setting in place new rules as to who can prescribe the drug – hydroxychloroquine – which was linked to several deaths last week overseas.

In announcing the rules, the TGA warned that “these medicines pose well-known serious risks to patients including cardiac toxicity (potentially leading to sudden heart attacks), irreversible eye damage and severe depletion of blood sugar (potentially leading to coma).”

It can also make your hair fall out

Hydroxychloroquine made worldwide headlines last week after US President Donald Trump recklessly declared the drug a “game changer” in the fight against COVID-19 and said it had been approved for widespread use.

This isn’t true.

As reported in The New Daily, the compound is one of a number of drugs being investigated in clinical trials, including trials launched by the World Health Organisation.

The US Food and Drug Administration has approved off-label use of the drug as a last-ditch measure for patients on the brink of death.

Since then, according to a Melbourne GP speaking anonymously to The New Daily, people have been stocking up on malarial medicines, without understanding how toxic they can be.

Pharmacists tell doctors to desist

In an open letter to doctors, as reported in Australian Doctor, the Pharmaceutical Society of Australia (PSA) warned against “reckless” prescribing for themselves or family members as a COVID-19 treatment.

“If this medication does indeed have the efficacy that we would desire against COVID-19, then it needs to be prescribed and used judiciously,” PSA president Associate Professor Chris Freeman wrote.

He said Australian pharmacists were reporting unprecedented demand for the drug, including doctors prescribing for other doctors and their families and “bulk amounts” being prescribed by non-medical prescribers.

Gold Coast GP Professor Nick Zwar, from Bond University, told Australian Doctor the decision to prescribe hydroxychloroquine in the setting of COVID-19 should rest with infectious disease specialists who are treating hospitalised patients.

“It needs to be reserved for people who are very sick with the condition in the first instance until it is shown to be effective. In fact, widespread use when it’s not indicated may be harmful,” he said.

The TGA advised “there are no medicines that have been approved by the TGA for treatment of COVID-19, therefore prescribing of any medicine for the treatment of COVID-19 is considered off-label use”.

“There is currently no clear data to inform clinical guidance on the use, dosing, or duration for COVID-19 treatment.”

Protecting supplies of the drug for people who need it

The TGA, to help maintain the supply of hydroxychloroquine in Australia and discourage inappropriate prescribing, has placed restrictions on the medical specialists who can initiate prescribing of the medication.

“Initiation of hydroxychloroquine is restricted to the following medical specialties as per the Medical Board list: Dermatology; intensive care medicine; pediatrics and child health; physician; and emergency medicine,” the TGA stated.

General practitioners and doctors in training can prescribe these medicines for continued treatment of patients where treatment was previously initiated by one of the specialists.

Hydroxychloroquine is used to treat rheumatoid arthritis, mild systemic and discoid lupus erythematosus (an autoimmune disease), as well as the suppression and treatment of malaria.