Is there a COVID medicine I can take without going to the hospital?
It remains frustrating that no antiviral pill has been approved for use treating COVID-19 (see my other Parkchester Times articles for more on this topic). It has been controversial, for good reason, that the antimalarial drugs chloroquine and hydoxychloroquine were made available without good evidence of efficacy, exposing patients to added heart injury risk (the FDA now recommends AGAINST their use). But the need to treat people at home, without admitting them to a hospital, is real. There are three medicines you might consider taking at home should you test positive for COVID 19: colchicine, losartan, and famotidine. All three are FDA approved drugs currently in trials for use against coronavirus. None of those trials have reported their results as of this writing, so we are guessing as to the benefit. Take everything in this article with a grain of salt, and discuss your options with your doctor as soon as that can be arranged.
Colchicine (Colcrys, Mitigare)
If you want to participate in a drug trial from home, and if you qualify, consider colchicine. Colchicine is not an antiviral, but a botanically derived anti-inflammatory used by rheumatologists to treat gout, acting on cytokine proteins as it dissolves uric acid crystals. Broadly speaking it's an immunosuppressant, but it’s different from the immunosuppressants used to treat MS and combat transplanted organ rejection.
Recent reporting suggests that the coronavirus may be using aspects of the human immune response to promote its invasion of cells. It’s certain that when our bodies overreact by producing a storm of cytokine proteins, especially but not limited to interleukin-6, this pro-inflammatory response creates potentially deadly COVID-19 symptoms, including difficulty breathing. Is colchicine’s mechanism of action sufficiently targeted to make it the needed immunomodulator? Is it advantageous to begin treatment with an anti-inflammatory before onset of the most severe symptoms? These are the questions the study is designed to answer.
IMPORTANT: Do not confuse COLCHICINE and CHLOROQUINE! These are two entirely different drugs that do different things. Persons over 70 are eligible for the colchicine study. Persons over 40 are eligible if they have a pre-existing condition that puts them at risk. Pills ship immediately upon participants testing positive for the coronavirus, so the ideal time to call (877) 536-6837 or contact the study using information at https://clinicaltrials.gov/ct2/show/NCT04322682 might be while awaiting test results. It’s run out of Montreal, Canada, with NYU Medical School and the University of California / San Francisco participating.
The colchicine trial has a control arm involving a placebo, so participants won’t know for certain that they’re receiving the medication. If participating in a clinical trial is not for you, if you don’t meet the eligibility criteria, or if you want your treatment with colchicine monitored and adjusted based on your symptoms and tests, your other option is to consult a physician experienced with colchicine, ideally a rheumatologist.
If you’re already taking something for hypertension or heartburn, or you should be, consider talking with your doctor about switching to one of the medications thought potentially to have an effect against coronavirus: losartan for hypertension (high blood pressure) or fomatidine for heartburn (indigestion, acid reflux).
The COVID-19 virus attaches itself molecularly to a receptor involved in regulating blood pressure called ACE2. Blood-pressure medications interact with this receptor in various ways, and researchers are interested in whether any existing medications either block or promote viral entry. LiveScience health reporter Nicoletta Lanese explains that most of the blood pressure medications referred to as ACE inhibitors target the ACE1 receptor, so they do not block viral entry via ACE2. However some researchers have speculated that Losartan, an angiotensin II receptor blocker (ARB), might inhibit viral entry.
Potential therapeutic options to address AT1 receptor-mediated lung injury in patients with COVID-19
(A) Mechanism in a healthy individual. (B) Mechanism in an individual with COVID-19. AT1=angiotensin 1. AT2=angiotensin 2. ACE1=angiotensin converting enzyme 1. ACE2=angiotensin converting enzyme 2. AT1R=type 1 angiotensin 2 receptor. AT1-7=heptapeptide angiotensin(1-7). ACEI=angiotensin-converting enzyme inhibitor. ARB=angiotensin receptor blocker. COVID-19=coronavirus disease 2019.
In 2005, Kuba and colleagues found that mice treated with losartan after acid aspiration-induced acute lung injury (with addition of SAR S-CoV spike protein) had significantly diminished lung injury and pulmonary oedema compared with mice treated with placebo. … [In 2014, Zou and colleagues found] treatment of mice after infection with H5N1 influenza with losartan versus placebo was associated with reduced pulmonary oedema, pulmonary neutrophil infiltration, and significantly improved survival. [Ref: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30153-3/fulltext]
The lead author of the letter to The Lancet quoted above is Dr. Christopher Tignanelli, a principal investigator leading clinical trials of Losartan to treat COVID-19 patients in Minnesota. Other trials are taking place in Kansas City and San Diego, and there’s a comparative study of various potential COVID medications in Cooperstown, NY that includes Losartan.
None of these studies are in the New York City area, but Losartan has been an FDA approved blood pressure medication for decades. There is therefore every reason to discuss with your doctor whether Losartan is right for you.
Famotidine (Pepcid AC)
The locus of research on famotidine use in treating COVID-19 is Northwell Health’s Feinstein Institutes for Medical Research in Manhasset. Northwell Health also runs Lenox Hill Hospital in Manhattan and others across downstate New York. The observations of Massachusetts General Hospital’s globe-trotting infectious disease doctor Michael Callahan, the computer modeling of Alchem Laboratories of Florida and interest & funding from the US Biomedical Advanced Research and Development Authority (BARDA) brought famotidine to the point of human trials. It’s not a certainty that the over-the-counter stomach medicine we all know as Pepcid AC will treat COVID-19, but the theory that it might help has a pedigree.
The procedures and dosages under study at Northwell are in the don’t try this at home category. If you and your doctor want to utilize famotidine before the research is complete and FDA renders a verdict, follow the dosages for indigestion. The risks of this medication are mostly known assuming you follow the instructions on the label. For information on famotidine dosage from drugs.com, click here. For an update, see this CNN story.
Other Possibilities to watch
The antiviral favipiravir is also a pill. Favipiravir studies have not yet come to New York, but as we start testing more broadly in preparation for returning to work it seems clear that authorities ought to take another look at early introduction of an antiviral in pill form.
Something else to watch is whether the Leronlimab clinical trial at Montefiore will be expanded to include outpatients. Currently Leronlimab is not a pill, but a slow-release shot. One might reasonably get an injection, walk away, and come back in a few days for a second.
Be well my friends, and if you should test positive for COVID, discuss the above with your doctor early, before the situation becomes critical. A table of your options is available here.