Questions and Answers

There may be an increase in risk factors. There is a higher incidence of chronic pain amongst older people, who are more risk of COVID-19. Physical deconditioning as a result of chronic pain may lead to individuals being more vulnerable. Anxiety and depression is highly reported amongst people with chronic pain and COVID-19 possibly puts more strain on underlying mental health issues.

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) commonly used for pain (and widely used overseas for the control of fever). It has previously been reported to heighten the risk of contracting the virus and developing a severe form of the illness. These previous reports were based on animal studies rather than direct reports from the clinical outcomes within the pandemic. Stopping its use for pain is not recommended; caution remains about its use to control fever although there is little basis for this in the current evidence.

Chronic use of high doses of opioids may pose a higher risk for more severe disease severity with COVID-19 due to associated side effects such as potential for decreased immune responses, sleep-disordered breathing, ventilatory impairment in post-operative and obese groups and some indications of pathophysiological causes for the increased the risk of pneumonia. 

If a person taking opioids regularly for pain develop symptomatic COVID-19, then consideration of careful opioid dose reduction (but not full withdrawal) should be considered because of the potential for heightened sensitivity to adverse effects, including potential for respiratory function depression.

However it is important to note that the link between COVID-19 and opioid use is purely speculative, given a lack of any published data looking specifically at associations between COVID-19 and opioid use.

It is also important to note that rapid opioid dose reduction also poses risks including more severe pain and neuro-psychological effects so any changes to usual medication should follow careful consideration in consultation with a prescribing practitioner.

Evidence for hydroxychloroquine and similar anti-malarial drugs is mixed and based on loosely controlled studies. Even studies indicating its promise don't show it's a miracle cure. There are also other clinical studies that showed it is not effective against COVID-19 as well as several other viruses. And, more importantly, it can have dangerous side effects, as well as giving people false hope. The latter has led to widespread shortages of hydroxychloroquine for patients who need it to treat malaria, lupus and rheumatoid arthritis, the indications for which it was originally approved. Despite news reports from around the world touting it as a wonder drug, NPS Medicinewise is urging Australians to remember that the use of the medicine hydroxychloroquine for the prevention or treatment of COVID-19 is experimental

17 April 2020

Medicines Australia has been firmly advised by TGA this week that there are enough Hydroxychloroquine supplies in Australia to meet patient demand and we have heard from members that they are expecting more supplies to come in.

If patients are struggling to get it from their pharmacy, they recommend they contact the pharmaceutical company direct.  

Off-label use

There has been increased media coverage around the off-label use of hydroxychloroquine in the management of COVID-19 based on preliminary results from independent studies from different countries. The situation is raising many questions from our different stakeholders.

To date there is insufficient clinical evidence to draw any conclusions over the clinical efficacy or safety of hydroxychloroquine (or chloroquine) in the management of COVID-19. The preliminary results from different independent studies require further analysis and more robust and larger clinical studies to assess the patient benefit/risk profile of Plaquenil® in COVID-19.

Current registrations for hydroxychloroquine

Today in Australia, hydroxychloroquine is registered in rheumatoid arthritis, mild systemic and discoid lupus erythematosus and the suppression and treatment of malaria. 

Any use of this medicine in the management of COVID-19 is considered an off-label use (i.e. in absence of a marketing authorisation for the indication of COVID-19).

Therapeutic Goods Administration changes that support on label prescribing of this product in Australia

These changes mean that:  

• Initiation of hydroxychloroquine is now restricted to the following medical specialties as per the Medical Board list: dermatology; intensive care medicine; paediatrics and child health; physician; and emergency medicine.  
• General practitioners and other medical practitioners (e.g. hospital Resident Medical Officers (RMOs) and doctors in training) can continue to prescribe repeats for hydroxychloroquine to patients in line with the registered indications for patients in whom the medication was prescribed prior to 24 March 2020.  
• 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.