My heart health won’t tolerate Hydroxychloroquine.

I have always found that when it comes to medical matters, the best approach is no panic, no politics, and just the facts.  This is exactly what I have come to expect over the years. It is a team approach practiced by all my doctors even though they do not reside in the same practice.  It is an approach that I hope this country finds its way to immediately.  Because the price – which is too valuable to waste – is your health and your life.
 
Medical matters, of course, include matters of medicine.  When I listen to oral presentations or commercials on drugs – prescription, over the counter or even herbal supplements – I am always focused on hearing what the benefits are and what the side effects are.  Because even if the benefit is that you get rid of one condition, if you develop an even more serious condition or God forbid die, well that to me would be an unacceptable risk. 

I am very careful about what I put in my mouth, to include food, drugs and even herbal teas.  Avoiding certain drugs has become a fact of life for me.  You may have recalled other posts where I discussed that a heart patient like me should not be taking non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin compounds, Ibuprofen or Naproxen sodium.  This is because (NSAIDs) can trigger or worsen heart failure by causing sodium and fluid retention and making diuretic medications less effective. 

I also cannot take decongestants.  An American Heart Association article says:

• Decongestants – like pseudoephedrine or phenylephrine – constrict blood vessels. They allow less fluid into your sinuses, "which dries you up," said Dr. Erin Michos, associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore.  "But if you have high blood pressure or heart disease, the last thing you need is constricting blood vessels," she said. "It can exacerbate or worsen the condition."  The biggest concerns are for people who have had a heart attack or stroke, or have heart failure or uncontrolled high blood pressure, Michos said.

The minefield of medications is not just my issue.  Watch any drug commercial and you become well aware that people with a large number of conditions are at risk with certain drugs.  You will commonly here “Do not take (insert name of drug) if you have (insert name of condition).  Because I now have a heightened awareness of how drugs can impact me and others, I listen/read whatever anything I can find on drugs I might need to take.  That awareness has increased since I have been following the path of various vaccine trials and potential therapeutic drugs to treat the corona virus.

When the issue of arose several months ago as to whether hydroxychloroquine could be a potential treatment for Covid 19, I saw it was linked with Azithromycin (also commonly known as the Z-pak).  I was prescribed this antibiotic when I had a bout with bronchitis back in the fall.  I took the first dose because I was so miserable with bronchitis.  I did not read the world atlas size patient insert until after I took the pill and saw the warning for heart patients about arrhythmia.  I e-mailed my cardiologist to see whether this was a good course of antibiotic treatment for me to continue. 
 
He replied that this is not the favorite drug for cardiac patients. The main concern is a condition called QT prolongation which can trigger bad rhythms.  Fortunately, I had never heard of QT prolongation, which meant I probably didn’t have it.  Additionally, I have a defibrillator in place which helps.  But in the future, the cardiologist suggested I would do better with a cephalosporins rather than this product, a recommendation I appreciated and sent to my family doctor.

When I saw the stories on the proposed combo drug for Covid, I thought – yikes! If they are pairing hydroxychloroquine with a Z-pak, I don't think that would be a wise option for me if I ever got Covid.  Then I forgot about it until the news became never-ending and I decided to do more research.
 
Here is what the FDA said about the drug on April 24:   “The FDA is aware of reports of serious heart rhythm problems in patients with COVID-19 treated with hydroxychloroquine or chloroquine, often in combination with azithromycin and other QT prolonging medicines.  We are also aware of increased use of these medicines through outpatient prescriptions.  Therefore, we would like to remind health care professionals and patients of the known risks associated with both hydroxychloroquine and chloroquine. We will continue to investigate risks associated with the use of hydroxychloroquine and chloroquine for COVID-19 and communicate publicly when we have more information.” 
 
Nothing in the above statement is unusual because it is the FDA’s job to report on dangerous drug impacts.  It is also the FDA’s job to use the emergency use authorization process to gain information on the efficacy of a drug.  However, the coverage of this topic appears to have taken on a political edge.  As always, when things get too politically charged, I resort to the very simple practice of trying to find the facts especially as they apply to me and my own health.
 
I already knew that hydroxychloroquine is an approved drug for conditions other than Malaria, such as Rheumatoid Arthritis and Lupus.   I found that Plaquenil is one such drug.  I decided perhaps the best information for me might be similar to what you would find in a patient insert.  I found an access data page at the FDA website which gave information for the drug Plaquenil:

Cardiac Effects, including Cardiomyopathy and QT prolongation: Postmarketing cases of life-threatening and fatal cardiomyopathy have been reported with use of PLAQUENIL as well as with use of chloroquine. Patients may present with atrioventricular block, pulmonary hypertension, sick sinus syndrome or with cardiac complications. ECG findings may include atrioventricular, right or left bundle branch block. Signs or symptoms of cardiac compromise have appeared during acute and chronic treatment. Clinical monitoring for signs and symptoms of cardiomyopathy is advised, including use of appropriate diagnostic tools such as ECG to monitor patients for cardiomyopathy during PLAQUENIL therapy. Chronic toxicity should be considered when conduction disorders (bundle branch block/atrio-ventricular heart block) or biventricular hypertrophy are diagnosed. If cardiotoxicity is suspected, prompt discontinuation of PLAQUENIL may prevent life-threatening complications.

PLAQUENIL prolongs the QT interval. Ventricular arrhythmias and torsades de pointes have been reported in patients taking PLAQUENIL (see OVERDOSAGE). Therefore, PLAQUENIL should not be administered with other drugs that have the potential to prolong the QT interval (see DRUG INTERACTIONS)
 
Wow – not only does it once again mention QT prolongation it mentions other heart issues one could develop.  As you may recall, my diagnoses over the last 8 years have included lots of those heart terms in the first quoted paragraph, especially cardiomyopathy!  Why would I want to continue to aggravate those heart conditions?  What this tells me is that if I had Malaria, Rheumatoid Arthritis or Lupus, my existing cardiomyopathy would make it mandatory for me to stay away from Plaquenil as a treatment. But if an ingredient in Plaquenil is hydroxychloroquine, logically it would seem that hydroxychloroquine in general would be off limits as well.  In fact, my conclusion is this:  Double yikes.  If I would take the Z-pak and hydroxychloroquine for Covid, it would likely be a double whammy to my health and most likely my life.
 
Then I found that another FDA fact sheet on emergency use authorization for hydroxychloroquine says:  Hydroxychloroquine sulfate should not be used in patients with a prolonged QT interval at baseline or at increased risk for arrythmia.”  The fact sheet is yet another warning bell that this drug is not for me.
​
For the record, I avoid talking about politics in my blog.  However, as I also live on this planet, I am again unable to avoid the fact that the topic of hydroxychloroquine is starting to be bandied about like a political football.  This frustrates me to no end because a lot of political hot air and media frenzy does not make it easy for the doctor and the patient to do their jobs.  Their jobs of course are helping the patient to obtain the best health and the chances of survival based on their particular health circumstances.  To me, this very important point has been forgotten. 
 
My post is not political.  It is not about the success or failure of the drug’s clinical trials; or whether you can take this drug for “preventive” purposes; or whether you emergency use authorization or off-label use should be available to allow people to take this drug.  The point of my post as always is about heart health for those of us who have heart issues – especially of the electricity of the heart. 
 
The fact that other people are taking this drug and may think others are weak, stupid or whatever for not wanting to take it does not impact me.  As my mother used to say to me:  If Mary Smith jumped off a bridge would you want to jump off a bridge?  And the answer is heck no – if something is dangerous or unwise for me personally to do, I really don’t care if the entire world is doing it.  I choose not to. 
 
God gave me an awesome life filled with blessings and opportunities.  He also gave me this heart and it has lasted me a good while, even though it is enlarged, weak, and the electrical system leaves a lot to be keeps short-circuiting.  Regardless, my heart keeps on pumping blood so I can enjoy a comfortable and even full life, despite the pandemic.  I have also gratefully accepted the gift of really talented doctors and nurses who help me understand what I need to do to keep this heart pumping at a level that keeps me moving in a positive direction.  These doctors have already told me about the risks of a number of drugs to my heart health, including those that can create more rhythm issues for my already out of sync heart.  Why would I challenge God, my heart, and my doctors by knowingly taking something that would only cause more havoc for my heart?
 
Nope – I’m going to show respect by promising that I will not take any drugs to prevent or treat the virus that may cause even more arrythmias and more heart issues, because quite frankly, I have enough of those already.  It will be hard enough to fight off Covid 19 without further damaging my heart and messing up my already exceedingly fragile and irregular heart rhythms. 
 
God also gave me the ability to weigh options and to help myself.  You might ask what options I have weighed and implemented in place of taking a risky medication?  Well, I will wear a mask, and practice social distancing and washing of hands early and often.  I will do this as long as it takes for the virus to disappear or for a vaccine to be available to protect me.  Most important, I will pray early and often and devoutly not only for me but for others.  Because it is my conversations with God, and the messages he wants me to give others who need faith - it is these things that are keeping me sane and focused.  I’m not getting it from the politicians and the talking heads.  I’m getting it straight from God, the guardian of my heart and of the universe.