Understanding Hydroxychloroquine: Uses, Controversies, and Current Role in Medicine

Hydroxychloroquine, once a relatively obscure medication used primarily for autoimmune diseases, gained global attention during the COVID-19 pandemic. But what is hydroxychloroquine, how is it used medically, and what led to its sudden fame (and infamy)? In this comprehensive blog, we’ll explore the history, uses, scientific evidence, controversies, and the current state of hydroxychloroquine in clinical practice.

What Is Hydroxychloroquine?

Hydroxychloroquine (brand name: Plaquenil) is a medication originally developed in the 1950s as a less toxic derivative of chloroquine, which was widely used to treat malaria. It belongs to a class of drugs known as disease-modifying antirheumatic drugs (DMARDs) and has anti-inflammatory and immunomodulatory properties.

Hydroxychloroquine is on the World Health Organization’s List of Essential Medicines, indicating its importance in a basic health system.

Medical Uses of Hydroxychloroquine

1. Malaria Prevention and Treatment

Hydroxychloroquine was first used as an antimalarial. It works by interfering with the growth of parasites in the red blood cells. However, due to increasing resistance by Plasmodium species, it is now less commonly used for this purpose.

2. Systemic Lupus Erythematosus (SLE)

One of the most important current uses of hydroxychloroquine is in the management of lupus. It helps reduce flares, joint pain, skin issues, and fatigue. Long-term use has been shown to improve survival rates in lupus patients.

3. Rheumatoid Arthritis (RA)

Hydroxychloroquine is often prescribed alongside other medications like methotrexate to control symptoms of rheumatoid arthritis. Its mild side effect profile makes it suitable for long-term therapy.

4. Other Autoimmune Diseases

Some physicians prescribe hydroxychloroquine off-label for conditions like Sjogren’s syndrome, cutaneous lupus, and dermatomyositis.

How Does Hydroxychloroquine Work?

Hydroxychloroquine’s mechanism of action is still not fully understood, but it’s believed to:

  • Interfere with communication between immune cells.

  • Inhibit toll-like receptor (TLR) signaling pathways, which are involved in autoimmune responses.

  • Raise the pH inside lysosomes, disrupting antigen presentation.

These effects reduce inflammation and immune system overactivity, which is why it’s useful in autoimmune conditions.

Dosage and Administration

  • Typical dosage: 200–400 mg daily.

  • Form: Oral tablets.

  • Monitoring: Because long-term use can lead to retinal toxicity, regular eye exams are recommended.

Side Effects and Risks

Hydroxychloroquine is generally considered safe, especially compared to many other immunosuppressive drugs. However, potential side effects include:

Common Side Effects:

  • Nausea

  • Stomach cramps

  • Headache

  • Dizziness

Serious (but rare) Side Effects:

  • Retinal damage: May lead to irreversible vision loss if not detected early.

  • Cardiac issues: In rare cases, can cause QT prolongation and arrhythmias.

  • Hypoglycemia: Especially when combined with diabetes medications.

Routine monitoring and dose adjustments are essential for long-term users.

The COVID-19 Controversy

Initial Hype

In early 2020, during the first wave of the COVID-19 pandemic, hydroxychloroquine became the subject of intense global attention. A small study in France suggested that it might reduce the viral load of SARS-CoV-2, the virus that causes COVID-19. Soon after, media outlets and political figures promoted it as a potential “miracle cure.”

Notably, some prominent figures publicly endorsed hydroxychloroquine, leading to a spike in demand and panic buying. The drug became so politicized that its scientific evaluation was sometimes overshadowed by misinformation and public opinion.

Scientific Studies and Trials

As more rigorous studies were conducted, initial optimism was dampened. The majority of randomized controlled trials (RCTs) and meta-analyses found:

  • No significant benefit in preventing or treating COVID-19.

  • Potential risks of heart rhythm disturbances, especially when combined with azithromycin.

In 2020, the FDA revoked its Emergency Use Authorization (EUA) for hydroxychloroquine in treating COVID-19. The World Health Organization and NIH also stopped their trials due to lack of efficacy.

Lasting Impact

The hydroxychloroquine saga highlighted how a mix of desperation, hope, and politics can drive medical decisions without sufficient evidence. It also sparked conversations about the importance of evidence-based medicine, the role of social media, and the danger of misinformation in healthcare.

Ethical and Logistical Challenges

Drug Shortages

As demand surged in 2020, many lupus and RA patients were unable to access their prescribed medication. Pharmacies reported widespread shortages, raising ethical questions about allocation during a public health emergency.

Off-Label Prescribing

Physicians began prescribing hydroxychloroquine off-label for COVID-19 despite limited evidence. This raised concerns about the boundaries of clinical judgment and the need for clearer guidelines during emergencies.

Trust in Science

The conflicting reports, retracted studies (like the high-profile Lancet paper in 2020), and polarized public discourse eroded public trust in medical science and regulatory bodies.

Where Does Hydroxychloroquine Stand Today?

Post-COVID Reputation

Despite the controversy, hydroxychloroquine remains a first-line treatment for lupus and an important drug in rheumatology. Its reputation has been somewhat rehabilitated within the medical community, though public perception remains divided.

Ongoing Research

Some researchers are still exploring hydroxychloroquine for:

  • Other viral infections

  • Cancer immunotherapy (as an autophagy inhibitor)

  • Metabolic disorders

However, these applications are still experimental.

Lessons Learned from the Hydroxychloroquine Debate

1. Science Takes Time

Initial laboratory or observational findings need validation through well-designed clinical trials before influencing clinical practice.

2. Misinformation Can Be Dangerous

Unchecked media hype and social media can spread misinformation faster than the medical community can respond.

3. Trust in Institutions Is Crucial

Public health agencies must communicate clearly and consistently, especially during crises.

4. Patients Must Not Be Forgotten

Increased demand for a drug should not compromise access for patients with chronic illnesses who rely on it.

Final Thoughts

Hydroxychloroquine is far more than just a controversial COVID-era drug. It’s a decades-old medication that plays a crucial role in treating serious autoimmune diseases. The pandemic thrust it into the spotlight under extraordinary circumstances, but its long-term value remains grounded in solid science and clinical experience.

As we move forward, the hydroxychloroquine story serves as a cautionary tale—and a reminder of the importance of rigorous science, ethical responsibility, and public health communication.

FAQs About Hydroxychloroquine

Q: Is hydroxychloroquine still used for COVID-19?
A: No. Most health authorities, including the WHO and FDA, recommend against using hydroxychloroquine for COVID-19 due to lack of effectiveness and potential risks.

Q: Can I take hydroxychloroquine to prevent getting sick?
A: No. It is not approved or recommended for preventive use in viral infections, including COVID-19.

Q: How safe is hydroxychloroquine long term?
A: For most people with proper monitoring (especially eye exams), hydroxychloroquine is considered safe for long-term use in autoimmune conditions.

Q: Why was there such a big controversy around it?
A: The combination of early hope, political endorsements, conflicting studies, and media amplification led to widespread use before strong scientific evidence was available.

References

  • World Health Organization (WHO) – Essential Medicines List

  • U.S. Food and Drug Administration (FDA) – Drug Safety Communications

  • National Institutes of Health (NIH) – COVID-19 Treatment Guidelines

  • ClinicalTrials.gov – Hydroxychloroquine Trials

  • American College of Rheumatology – Guidelines on DMARDs