CAN CONTROVERSIAL DRUG PREVENT CORONAVIRUS?

Q: We’re still hearing about hydroxychloroquine as a treatment for the coronavirus. Most medical authorities have concluded it is neither safe nor effective as a treatment for the virus.

Observational studies from some practitioners report it can be effective when used early on for treating the coronavirus – together with zinc and azithromycin – but it has limited effectiveness when a COVID-19 patient is seriously ill.

Have any researchers studied prescribing hydroxychloroquine prophylactically to at-risk people, such as frontline medical workers? I ask because I fall into that category. Is there any scientific research on the prophylactic use of hydroxychloroquine?

A: We could find only one randomized controlled trial of hydroxychloroquine to prevent COVID-19 in exposed individuals (New England Journal of Medicine, Aug. 6, 2020).

The investigators recruited over 800 people exposed for more than 10 minutes at a distance of less than 6 feet to infected coronavirus patients. Many were health care workers exposed on the job.

The volunteers started taking HCQ or placebo within four days of their exposure. After two weeks there was no significant difference between the two groups in terms of symptoms or COVID-19 test results.

Q: What can you tell me about the safety and longterm use of Ozempic to treat Type 2 diabetes? My husband’s A1C is around 7.2.

The endocrinologist wants to try Ozempic along with his metformin and glimepiride to see if he can do better. He is not overweight and is careful with his diet. I’m worried about injectables at his age of 64. What are the longterm effects?

A: Ozempic (semaglutide) is prescribed to improve blood sugar control for people with Type 2 diabetes. It was approved in the U.S. in 2017, so we have only three years of experience on long-term effects. We worry that your husband’s glimepiride, a sulfonylurea medicine, could interact with the Ozempic injection. This combination could increase the risk of a serious episode of low blood sugar (hypoglycemia). Symptoms can include fatigue, confusion, blurred vision, seizures and coma.

A common side effect is digestive distress. Other adverse reactions may include thyroid cancer and pancreatitis. If your husband has the eye disease diabetic retinopathy, using Ozempic might make it worse.

Q: Six years ago, my doctor prescribed Voltaren Gel for arthritis in my knee. She assured me that the warnings only applied to the oral form of the drug. I got excellent relief.

After three weeks, however, I suddenly developed swelling in that leg. My blood pressure went up to 220/110 and I ended up in the emergency room. They monitored me for six or seven hours until my blood pressure returned to normal. Voltaren, even topical, can cause some serious side effects.

A: Voltaren Gel for arthritis pain is now available without a prescription. The Food and Drug Administration has warned that both oral and topical NSAIDs like diclofenac (Voltaren Gel) can lead to edema and high blood pressure. People who cannot tolerate NSAIDs like diclofenac, ibuprofen and naproxen may benefit from nondrug approaches to manage joint pain. You can learn about these in our eGuide to Alternatives for Arthritis. This resource is available in the Health eGuides section of www.PeoplesPharmacy.com.