American Frontline Doctors and Hydroxychloroquine

Hydroxychloroquine (HCQ) has been FDA approved for 65-years. Once a medication is FDA approved it can be prescribed by a physician for any reason. If the medication is prescribed for the specific reason the drug manufacturer requested (e.g. pneumonia) that is called “on-label” use, and if it is prescribed for a different reason (e.g. bladder infection) that is called “off-label” use. Being on or off label is not related to the drug’s safety or efficacy. On-label designation means the FDA permits the drug manufacturer to advertise for a specific diagnosis. Physicians prescribe “off-label” 21% of the time and never consider if a drug is on or off label in their daily practice. There are many reasons for this including: physicians are already regulated by medical malpractice regulations and it is very expensive for a drug manufacturer to get additional “on-label” designations.

The other reason doctors are always allowed to prescribe off label is because it is desirable for doctors to be able to identify new treatments for new situations. When American doctors first starting treating Covid-19, they expected to be able to do as they always have done, which is to try safe medications they already knew including: ivermectin, budesonide, hydroxychloroquine, dexamethasone, zinc, vitamin D, vitamin C, azithromycin, among others. But during Covid-19, State Pharmacy Boards and State Governors have passed regulations that have restricted only hydroxychloroquine and only when being used for Covid-19! This dramatic departure from the way medicine has always been practiced is very alarming to people who are concerned about the doctor-patient relationship.

Learn about treatment protocols and preventative methods for COVID-19

For prevention, the Front Line COVID-19 Critical Care Working Group (FLCCC) recommends (updated April 26, 2021):
  • Vitamin D3: 1000–3000 IU/day. Note RDA (Recommended Daily Allowance) is 800–1000 IU/day. The safe upper-dose daily limit is likely < 4000 IU/day. Vitamin D deficiency has been associated with an increased risk of acquiring COVID-19 and from dying from the disease. Vitamin D supplementation may therefore prove to be an effective and cheap intervention to lessen the impact of this disease, particularly in vulnerable populations, i.e. the elderly and obese. (Amazon)
  • Vitamin C: 500 - 1,000 mg BID (twice daily) 
  • Quercetin: 250 mg daily. It is likely that vitamin C and quercetin have synergistic prophylactic benefit. Quercetin should be used with caution in patients with hypothyroidism and TSH levels should be monitored. (Amazon)
  • Melatonin: 6 mg before bedtime (causes drowsiness). (Amazon)
  • Zinc: 30 - 40 mg/day (elemental zinc). Zinc lozenges are preferred. (Amazon)
  • Ivermectin for 
    • prevention in high-risk individuals (> 60 years with co-morbidities, morbid obesity, long term care facilities, etc): 0.2 mg/kg per dose (take with or after meals) — one dose today, repeat after 48 hours, then one dose weekly. (also see ClinTrials.gov NCT04425850). 
    • Post COVID-19 exposure prevention: 0.2 mg/kg per dose (take with or after meals)  — one dose today, repeat after 48 hours.
For early outpatient protocol (COVID-19 positive), the Front Line COVID-19 Critical Care Working Group, FLCCC recommends (updated Apr 26, 2021):
  • Vitamin D3 — 4000 IU/day. (Amazon)
  • Vitamin C: 500 - 1,000 mg BID (twice daily) (Amazon)
  • Quercetin: 250 mg twice a day. (Amazon)
  • Melatonin: 10 mg before bedtime (causes drowsiness). (Amazon)
  • Zinc: 100 mg/day. Zinc lozenges are preferred. (Amazon)
  • Ivermectin: 0.2–0.4 mg/kg per dose (take with or after meals) — one dose daily, take for 5 days or until recovered. (Find a Doctor)
  • Fluvoxamine: 50 mg twice daily for 10–14 days. Add to ivermectin if: 1) minimal response after 2 days of ivermectin; 2) in regions with more aggressive variants; 3) treatment started on or after day 5 of symptoms or in pulmonary phase; or 4) numerous co-morbidities/risk factors. Avoid if patient is already on an SSRI (selective serotonin reuptake inhibitor).
  • Nasopharyngeal Sanitation: Steamed essential oil inhalation 3 times a day (i.e. vapo-rub) and/or chlorhexidine/benzydamine mouthwash gargles and Betadine nasal spray 2–3 times a day.
  • Aspirin: 325 m/day unless contraindicated.
  • Pulse Oximeter: FLCCC also recommend monitoring your oxygen saturation with a pulse oximeter and to go to the hospital if you get below 94%. (Amazon)
The medical evidence to support each drug and nutrient can be found under “Medical Evidence” on the FLCCC’s website.

Learn more about the extensive research behind Hydroxychloroquine

According to a real time meta-analysis of 243 hydroxychloroquine studies:

•100% of the 29 early treatment studies report a positive effect (13 statistically significant in isolation).
•Random effects meta-analysis with pooled effects using the most serious outcome reported shows 65% improvement for the 29 early treatment studies (RR 0.35 [0.25-0.50]). Results are similar after exclusion based sensitivity analysis: 66% (RR 0.34 [0.26-0.45]), and after restriction to 21 peer-reviewed studies: 65% (RR 0.35 [0.26-0.46]). Restricting to the 6 RCTs shows 49% improvement (RR 0.51 [0.32-0.82]). Restricting to the 13 mortality results shows 72% lower mortality (RR 0.28 [0.18-0.43]).
•Late treatment is less successful, with only 71% of the 166 studies reporting a positive effect. Very late stage treatment is not effective and may be harmful, especially when using excessive dosages.
•The probability that an ineffective treatment generated results as positive as the 243 studies to date is estimated to be 1 in 2 quadrillion (p = 0.0000000000000006).
•92% of Randomized Controlled Trials (RCTs) for early, PrEP, or PEP treatment report positive effects, the probability of this happening for an ineffective treatment is 0.0017.
•There is substantial evidence of bias towards publishing negative results. 87% of prospective studies report positive effects, and only 72% of retrospective studies do. Studies from North America are 3.6 times more likely to report negative results than studies from the rest of the world combined, p = 0.0000000021.
Negative meta analyses of HCQ generally choose a subset of trials, focusing on late treatment, especially trials with very late treatment and excessive dosages.
•While many treatments have some level of efficacy, they do not replace vaccines and other measures to avoid infection. Only 5% of HCQ studies show zero events in the treatment arm. Multiple approaches are required to protect everyone from all existing and future variants.

Source: hcqmeta.com (constantly updated)

Do you need a prescription for hydroxychloroquine? Yes, you do. 

An interactive map of state legislature regarding Hydroxychloroquine


A world map which shows how difficult or easy it is to obtain HCQ throughout the world


Source: https://www.americasfrontlinedoctors.org/hcq/map

Frequently Asked Questions about Hydroxychloroquine and COVID-19

THIS IS NOT MEDICAL ADVICE. Every situation is unique, and every person must check with his or her own physician, especially if you are taking any other medications.

How do I know if I need treatment with HCQ?

You must consult with a physician. That can be your regular physician or another physician such as a remote tele-medicine physician.

How do I find a doctor who knows about HCQ?

Please click Find a Doctor who will prescribe Hydroxychloroquine to find a HCQ-knowledgeable physician and pharmacy in your area.

What if my doctor will not prescribe (or does not believe in) HCQ?

Please click Find a Doctor who will prescribe Hydroxychloroquine to find a HCQ-knowledgeable physician and pharmacy in your area.

What is the treatment dose of HCQ?

Please refer to Dr. Zelenko's protocol and AAPS's treatment protocol

What is the prophylactic dose of HCQ?

Please refer to Dr. Zelenko's protocol and Dr. Simone Gold's protocol.

Is HCQ safe?

According to AmericasFrontLineDoctors: Yes, HCQ is amongst the safest of all prescription drugs in the USA. HCQ has been FDA approved for 65 years and is sold over the counter in most of the world. It is the #1 most used medication in India, the second-most populous nation on the planet with 1.3 billion people.The only allegations of HCQ not being safe relate to a potential heart problem. The media has stated this so often that many people, including physicians, think there is a potential heart problem. However, the evidence clearly demonstrates HCQ is very low-risk.

Is HCQ effective?

The short answer is yes, especially early or prophylactic. Please refer to the updated research on hydroxychloroquine above.

I have read from the internet that says HCQ is not safe – is it?

HCQ is FDA-approved for 65 years, is safe for babies, children, pregnant women, breastfeeding mothers, the elderly, and the immunocompromised who typically take it daily for years or decades. It derives from quinine found in tree barks. It is one of the most commonly used medications all around the world. It is listed on the WHO’s list of essential medications.

What is the difference between Hydroxychloroquine and Chloroquine?

Both are antimalarial drugs, and they are quite similar. The brand name for HCQ is Plaquenil, whereas it is Aranel for Chloroquine. They both are used to treat several forms of malaria, and HCQ is used in addition to treating lupus and arthritis, whereas Chloroquine is used off label to treat porphyria.

How is HCQ to be taken?

HCQ comes in a tablet form, and it is to be administered orally. If you are taking it to prevent malaria, one dose is usually taken on the same day of each week. It is usually taken once or twice a day for lupus and arthritis. If an adult is traveling to a place where malaria is common, HCQ is indicated for prophylaxis of malaria. The medication is started two weeks before exposure and continues till four weeks after departure from the endemic area. The use of HCQ for Sars-V2 or Covid-19 should only be taken with a Doctors prescription.

What is the dosage for HCQ?

One tablet of HCQ typically contains 200 mg HCQ. For malaria prophylaxis, the dosage could be 400 mg and is to be taken orally once a week. For acute malaria, higher mg doses can be taken as an initial dose, followed by doses taken at 6, 24, and 48 hours after the initial dose. For lupus, it could be 200-400 dose per day be divided into one or two doses. For arthritis, it can be prescribed to take 400-600 mg as initial dosage, and for maintenance, 200-400 gm dose should be taken per day.

What to do if I miss a dose?

Take the dose as soon as you remember it. If it is time for the next dose, then skipped dose should be missed, and regular dosing should be followed. Double dosing should not be taken to make up for a missed dose.

Where can I buy HCQ, and is there an online prescription for HCQ?

HCQ can be prescribed by a doctor and can only be purchased through a pharmacy with a doctor’s prescription. In the US, it cannot be bought over the counter, and a doctor’s prescription is required.

What is the price of HCQ tablets?

The cost of HCQ tablets generally ranges from $0.37 to $0.99. DoctorsHome is not a pharmacy, but the pharmacies that are connected to the online doctor’s network provide the most competitive pricing for HCQ. Feel free to talk to a doctor and get your questions and concerned answered if HCQ is right for you.

How long does HCQ take to work?

This is a question only a doctor can provide more insight into. There are too many variables to know how fast hydroxychloroquine will work and benefit you.

What are the side effects of HCQ?

Hydroxychloroquine has been approved by the FDA for about 70 years with practically no major side effects. It is rare to experience any side effects, but HCQ may cause headaches, nausea, rashes, diarrhea, and visual problems. Healthcare providers will prescribe a safe dosage according to the patient weight, and the patient is required to regularly monitor their eyes.

Is HCQ safe to use for the treatment of SARS-CoV2 and Covid-19?

Many scientists have tested HCQ for the treatment of Sars-V2 and Covid-19. Some doctors are looking at prophylaxis use of HCQ to help in a reduction in hospitalization rates and reduced the death rate. Also, many doctors have stated that the use of HCQ with zinc and azithromycin has shown promising results, and these medications can be used for treating Sars-V2 and Covid-19 patients. However, as of August 2020, HCQ is not FDA approved for the treatment of Covid, but still, FDA issued a EUA to allow HCQ for the treatment of Sars-V2 and Covid-19 based on best available evidence and at the doctors discretion. Based on ongoing clinical trials of Hydroxychloroquine results, the FDA will take action regarding the use of HCQ for Sars-V2 and Covid-19 once those clinical trials are completed.

UPDATE: COVID-19 is a highly dynamic topic. Please refer to the latest FLCCC protocol (April 26, 
2021 version).

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