Hydro-what?

Hydroxychloroquine. You’ve heard it 100s of times, especially in reference to the "c-word." But do you know anything about it beyond that hype? More than likely, you don't unless you have rheumatoid arthritis, lupus, or have the potential to be exposed to malaria. It's learning time!

Let's start with "what is it?" Hydroxychloroquine structurally is a quinine (which is a family of chemicals whose base is an aromatic ring and a nitrogen ring, similarly to how "steroids" refers to a family of chemicals with similar shapes) with a chlorine on it. Oh and of course an extra oxygen and hydrogen (the meaning of the prefix, hydroxy-).

Why is that important? This information tells you a lot about how the body absorbs the chemical and what the potential damage could be. Understanding the structure of a chemical can also help understanding potential interactions, for example caffeine can make the effects of a pain reliever happen more quickly when combined with a pain medication; this is why certain pain meds (Excedrin, for example) contain a medicine for pain with a small dose of caffeine. 

Now let's look at what hydroxychloroquine has been approved for in terms of use. That may sound weird, especially since currently it is associated with the COVID virus, however, hydroxychloroquine is an FDA approved treatment for certain diseases/disorders. Hydroxychloroquine is used to treat disorders that cause inflammation and pain in the joints, muscles, or fibrous tissues, for example rheumatoid arthritis. It is considered a first-line treatment for lupus erythematosus, which essentially means that it will be one of the first drugs considered as a treatment option. It is also used to treat certain types of malaria. Something to keep in mind with this drug, or any drug that you are considering taking for whatever reason are the potential side effects. In the case of hydroxychloroquine specifically, it has a narrow therapeutic index, which essentially means that there is little difference between the toxic and therapeutic doses. This is why hydroxychloroquine is something that needs to be prescribed and administered by a doctor and why it is important to monitor any side effects. In case you were wondering, the most common side effects are nausea, stomach cramps, diarrhea, itching, and headaches. For long term treatment, the side effects are the previously mentioned, altered eye pigmentation (most likely jaundice), acne, anemia, blisters, blood disorders, cardiomyopathy, convulsions, altered vision, diminished reflexes, tinnitus, skin inflammation, urinary incontinence, and muscle atrophy to name a few. Again, this is why it is important to understand the risks of medications as well as following instructions from and agreeing to be observed by a healthcare provider following treatment.

Now that we know some background on the drug, let's get to the meat - hydroxychloroquine as a cancer treatment. Wait, did someone say hydroxychloroquine as a cancer treatment? That's right, we did. There are several active studies, some in initial phases while others are at least stage II, that are looking at the use of hydroxychloroquine as a treatment for certain cancers both alone and coupled with other medications. Remember how we were talking about caffeine with painkillers? Similarly, hydroxychloroquine seems to work well with the chemotherapy drug cisplatin. While the study is still open, preliminary results look promising enough to eventually go to clinical trials.