The shortage of famotidine in the U.S. at least is self-inflicted. China has at least 3,000 pharmaceutical manufacturers, all hungry for money. The U.S. shortage of famotidine started long before any covid-19 interest (due to contamination of ranitidine [Zantac] with low levels of a chemical that can cause cancer - famotidine is often used as a substitute for ranitidine). Recently the FDA relaxed restrictions on compounding pharmacies, allowing these pharmacies to make copies of marketed drugs that are unavailable due to shortage or discontinuation; see www.beckershospitalreview.com/pharmacy/fda-clarifies-relaxed-compounding-rules-for-pharmacies.html, May 6, 2020. Could this rule change allow a path around the shortage - saving many lives if famotidine becomes accepted as a treatment or preventive for covid-19? We think so.
Another issue to keep track of is that *falls* prevent a much more immediate and much more common risk of serious injury or death, especially for older folks who might have a particular interest in reading this blog and in preventing COVID-19. Cetirizine (Zyrtec) causes immediate drowsiness and dizziness for me, even though it is touted for having a lower anticholinergic effect than other antihistamines. Many antihistamines, especially H1 blockers, can seriously dampen acetylcholine in the brain, which can dramatically increase risks for dementia, dizziness, and falling. (See: https://www.todaysgeriatricmedicine.com/archive/0313p6.shtml)
Famotidine also has a lower anticholinergic profile than other heartburn drugs, but it, too, can cause dizziness and drowsiness as potential side effects. (See: https://www.mayoclinic.org/drugs-supplements/famotidine-oral-route/side-effects/drg-20072972?p=1 , https://www.alzheimers.net/3-23-15-memory-loss-and-medication/ , and https://www.webmd.com/alzheimers/news/20160215/widely-used-heartburn-drugs-linked-to-dementia-risk-in-study#1 ) Additionally, there can be drug-drug interactions with famotidine that can cause kidney problems, especially in older users who may have weakened or stressed kidneys, or who may be taking other medicines and supplements that could also tax the kidneys.
Anyway, do your research, talk with a health care provider, and see whether a particular drug is right for you (and your own combination of other medicines, supplements, and medical concerns) before deciding to take something new.
Oh, jeepers, "Cheers!" somehow comes out, "Cheest!" Doggone covfefe fingers...
John, what do you think of this new drug? Lotta hype, or real promise?
"Relief, NeuroRx Say Emergency Treatment With RLF-100 Helps Critically Ill Covid Patients", by Reuters, Aug. 3, 2020, TEL AVIV https://www.nytimes.com/reuters/2020/08/03/world/europe/03reuters-health-coronavirus-relief-hldg-neurorx.html
Also, think you could weigh in on the hydroxychloroquine / azithromicin combination treatment? I've heard so much on either side of that question -- I'd like to hear an unbiased opinion.
Unfortunately I don't know much about either. I will need to research them in depth. There's so much going on that it's impossible to keep up.
Be aware that many things get hyped for stock-price purposes - pump and dump that threatens lives not just money.
Of course I've followed the hydroxychloroquine + controversies in the news. It will take considerable research to understand exactly why the advocates are pushing it - and what is behind the mainstream rejection. It's hard to trust either side.
A friend went on it as a preventive, and went to a hospital for some heart reason; that's all I know. This treatment seems dubious enough and dangerous enough that I would be very unlikely to take it myself.
Since it appears you've focused primarily so far on cheap treatments folks can use at home, what is your opinion on the use of mouthwashes, nasal rinses, and antiseptic lozenges and cough drops (and throat sprays) to shorten illness times and reduce infectiousness? I saw this article on it and wondered what your thoughts might be:
Also, I see today that the FDA has granted emergency authorization to the new rapid 15-minute antigen test from Abbott Labs, which costs $5 and requires no laboratory equipment. (The idea is that it could be deployed for massive distribution as a screening tool for schools, workplaces, home use, etc.) The first Abbott Labs antigen test had massive false negatives, but now they are claiming ~97% accuracy. What do you think -- shall we believe the hype?
Lastly, the famotidine and famotidine / cetirizine studies have had some time to play out by now... did we learn anything new?
Artemisin an anti-malaria drug shows early promises in the treatment of Covid. Artemisia Annua is currently tested by the Max-Planck Institute in Potsdam, Germany for its efficacy. See details here:
Artemisia Annua is an easy to grow plant in temperate climates that could provide an inexpensive solution to this disease for poorer regions that may not be able to afford the expensive solutions of the pharmaceutical industry.
Thank you, this is interesting, I hadn't heard of its use In COVID.
But there are quite a few articles. Here is a list that I found through the iCite database. Sorry it's a crude printout. But you can see the titles, and usually Google them for more information. I usually put the title (or part of it) in quotation marks.
List of titles: Repurposing Quinoline and Artemisinin Antimalarials as Therapeutics for SARS-CoV-2: Rationale and Implications. Repurposing Anti-Malaria Phytomedicine Artemisinin as a COVID-19 Drug. Modeling of SARS-CoV-2 Treatment Effects for Informed Drug Repurposing. Determinants of Antimicrobial Use for Covid-19 Related Symptoms among Nigerians. Novel and Controversial Therapies in COVID-19. Artemisia annua L. extracts inhibit the in vitro replication of SARS-CoV-2 and two of its variants. Antiviral and Immunomodulation Effects of Artemisia. Artemisia annua L. extracts inhibit the in vitro replication of SARS-CoV-2 and two of its variants Modeling of SARS-CoV-2 treatment effects for informed drug repurposing Targeting TGF-b pathway with COVID-19 Drug Candidate ARTIVeda/PulmoHeal Accelerates Recovery from Mild-Moderate COVID-19 [Potential therapies for COVID-19 cardiovascular complications using artemisinin and its derivatives intervene based on its cardiovascular protection]. From hydroxychloroquine to ivermectin: what are the anti-viral properties of anti-parasitic drugs to combat SARS-CoV-2? Cannabis sativa L. as a Natural Drug Meeting the Criteria of a Multitarget Approach to Treatment. Re-reading ACT, BCG, and Low COVID-19 in Africa. Chinese Medicine in Fighting against Covid-19: Role and Inspiration. Maintaining focus on administering effective malaria treatment during the COVID-19 pandemic. Treatment of COVID-19 with Chloroquine: Implication for Malaria Chemotherapy Using ACTs in Disease Endemic Countries. Repurposing Antimalarials to Tackle the COVID-19 Pandemic. Molecular screening of antimalarial, antiviral, anti-inflammatory and HIV protease inhibitors against spike glycoprotein of coronavirus. Safety and efficacy of artemisinin-piperaquine for treatment of COVID-19: an open-label, non-randomised and controlled trial. First principle study of silver nanoparticle interactions with antimalarial drugs extracted from Artemisia annua plant. Molecular detection of drug resistant polymorphisms in Plasmodium falciparum isolates from Southwest, Nigeria. Evaluation of the clinical performance of single-, dual-, and triple-target SARS-CoV-2 RT-qPCR methods. Molecular detection of drug resistant polymorphisms in Plasmodium falciparum isolates from Southwest, Nigeria. Hypoproteinemia is an independent risk factor for the prognosis of severe COVID-19 patients. In vitro efficacy of Artemisinin-based treatments against SARS-CoV-2
The whole list was too big for a Blogger comment. Here's part 2:
Pandemics and Traditional Plant-Based Remedies. A Historical-Botanical Review in the Era of COVID19. Antimicrobial mouthwashes (gargling) and nasal sprays administered to patients with suspected or confirmed COVID-19 infection to improve patient outcomes and to protect healthcare workers treating them. Rudolf Bauer: China anti-COVID-19 success is closely related with the role TCM played. Hydroxychloroquine: balancing the needs of LMICs during the COVID-19 pandemic. Molecular docking analysis of Withaferin A from Withania somnifera with the Glucose regulated protein 78 (GRP78) receptor and the SARS-CoV-2 main protease. Antimalarial artemisinin-based combination therapies (ACT) and COVID-19 in Africa: In vitro inhibition of SARS-CoV-2 replication by mefloquine-artesunate. Anti-SARS-CoV-2 Potential of Artemisinins In Vitro. First Principle Study of Silver Nanoparticles Interactions with Antimalarial Drugs Extracted from Artemisia Annua Plant Is the traditional Chinese herb "Artemisia annua" possible to fight against COVID-19? Antimalarial-agent artemisinin and derivatives portray more potent binding to Lys353 and Lys31-binding hotspots of SARS-CoV-2 spike protein than hydroxychloroquine: potential repurposing of artenimol for COVID-19. Clinical and biological data on the use of hydroxychloroquine against SARS-CoV-2 could support the role of the NLRP3 inflammasome in the pathogenesis of respiratory disease. Artesunate: could be an alternative drug to chloroquine in COVID-19 treatment? Comparative Docking Studies on Curcumin with COVID-19 Proteins Mass intake of hydroxychloroquine or chloroquine in the present context of the Covid-19 outbreak: Possible consequences in endemic malaria settings. Anti-malarial drug, artemisinin and its derivatives for the treatment of respiratory diseases. Phytocompounds of Rheum emodi, Thymus serpyllum and Artemisia annua inhibit COVID-19 binding to ACE2 receptor: In silico approach Plant Solutions for the COVID-19 Pandemic and Beyond: Historical Reflections and Future Perspectives. Artemisia annua: Trials are needed for COVID-19. Anti-malarial drug, artemisinin and its derivatives for the treatment of respiratory diseases. Anti-malarial drug, artemisinin and its derivatives for the treatment of respiratory diseases. Guidance for the management of adult patients with coronavirus disease 2019. Is Coronavirus Disease 2019 (COVID-19) seen less in countries more exposed to Malaria? Diagnosing malaria and other febrile illnesses during the COVID-19 pandemic. COVID-19 therapeutic options for patients with kidney disease. Existing bitter medicines for fighting 2019-nCoV-associated infectious diseases. In-silico Studies of Antimalarial-agent Artemisinin and Derivatives Portray More Potent Binding to Lys353 and Lys31-Binding Hotspots of SARS-CoV-2 Spike Protein than Hydroxychloroquine: Potential Repurposing of Artenimol for COVID-19. Repurposing antimalarials and other drugs for COVID-19. Preparedness is essential for malaria-endemic regions during the COVID-19 pandemic. Discovery of Anti-2019-nCoV Agents from 38 Chinese Patent Drugs toward Respiratory Diseases via Docking Screening
9 comments:
The shortage of famotidine in the U.S. at least is self-inflicted. China has at least 3,000 pharmaceutical manufacturers, all hungry for money. The U.S. shortage of famotidine started long before any covid-19 interest (due to contamination of ranitidine [Zantac] with low levels of a chemical that can cause cancer - famotidine is often used as a substitute for ranitidine). Recently the FDA relaxed restrictions on compounding pharmacies, allowing these pharmacies to make copies of marketed drugs that are unavailable due to shortage or discontinuation; see www.beckershospitalreview.com/pharmacy/fda-clarifies-relaxed-compounding-rules-for-pharmacies.html, May 6, 2020. Could this rule change allow a path around the shortage - saving many lives if famotidine becomes accepted as a treatment or preventive for covid-19? We think so.
Another issue to keep track of is that *falls* prevent a much more immediate and much more common risk of serious injury or death, especially for older folks who might have a particular interest in reading this blog and in preventing COVID-19. Cetirizine (Zyrtec) causes immediate drowsiness and dizziness for me, even though it is touted for having a lower anticholinergic effect than other antihistamines. Many antihistamines, especially H1 blockers, can seriously dampen acetylcholine in the brain, which can dramatically increase risks for dementia, dizziness, and falling. (See: https://www.todaysgeriatricmedicine.com/archive/0313p6.shtml)
Famotidine also has a lower anticholinergic profile than other heartburn drugs, but it, too, can cause dizziness and drowsiness as potential side effects. (See: https://www.mayoclinic.org/drugs-supplements/famotidine-oral-route/side-effects/drg-20072972?p=1 , https://www.alzheimers.net/3-23-15-memory-loss-and-medication/ , and https://www.webmd.com/alzheimers/news/20160215/widely-used-heartburn-drugs-linked-to-dementia-risk-in-study#1 ) Additionally, there can be drug-drug interactions with famotidine that can cause kidney problems, especially in older users who may have weakened or stressed kidneys, or who may be taking other medicines and supplements that could also tax the kidneys.
Anyway, do your research, talk with a health care provider, and see whether a particular drug is right for you (and your own combination of other medicines, supplements, and medical concerns) before deciding to take something new.
Oh, jeepers, "Cheers!" somehow comes out, "Cheest!" Doggone covfefe fingers...
John, what do you think of this new drug? Lotta hype, or real promise?
"Relief, NeuroRx Say Emergency Treatment With RLF-100 Helps Critically Ill Covid Patients", by Reuters, Aug. 3, 2020, TEL AVIV
https://www.nytimes.com/reuters/2020/08/03/world/europe/03reuters-health-coronavirus-relief-hldg-neurorx.html
Also, think you could weigh in on the hydroxychloroquine / azithromicin combination treatment? I've heard so much on either side of that question -- I'd like to hear an unbiased opinion.
Thanks again for the great work!
Unfortunately I don't know much about either. I will need to research them in depth. There's so much going on that it's impossible to keep up.
Be aware that many things get hyped for stock-price purposes - pump and dump that threatens lives not just money.
Of course I've followed the hydroxychloroquine + controversies in the news. It will take considerable research to understand exactly why the advocates are pushing it - and what is behind the mainstream rejection. It's hard to trust either side.
A friend went on it as a preventive, and went to a hospital for some heart reason; that's all I know. This treatment seems dubious enough and dangerous enough that I would be very unlikely to take it myself.
Hi John,
Since it appears you've focused primarily so far on cheap treatments folks can use at home, what is your opinion on the use of mouthwashes, nasal rinses, and antiseptic lozenges and cough drops (and throat sprays) to shorten illness times and reduce infectiousness? I saw this article on it and wondered what your thoughts might be:
https://www.forbes.com/sites/judystone/2020/08/27/mouthwashes-are-a-cheap-tool-in-the-fight-against-coronavirus/#450d14456306
Also, I see today that the FDA has granted emergency authorization to the new rapid 15-minute antigen test from Abbott Labs, which costs $5 and requires no laboratory equipment. (The idea is that it could be deployed for massive distribution as a screening tool for schools, workplaces, home use, etc.) The first Abbott Labs antigen test had massive false negatives, but now they are claiming ~97% accuracy. What do you think -- shall we believe the hype?
Lastly, the famotidine and famotidine / cetirizine studies have had some time to play out by now... did we learn anything new?
Thanks again for the great work! :-D
Tommy
Artemisin an anti-malaria drug shows early promises in the treatment of Covid. Artemisia Annua is currently tested by the Max-Planck Institute in Potsdam, Germany for its efficacy. See details here:
https://www.mpg.de/14663263/artemisia-annua-corona-virus
Frontiers in Pharmacology reports details of early small case studies. See details here:
https://www.frontiersin.org/articles/10.3389/fphar.2021.649532/full?fbclid=IwAR1kxF8nssEK-qr8JCSLrvo2wSBpV4WH_p62uxJdIUwBJzRYpSgPAHDjULI
Artemisia Annua is an easy to grow plant in temperate climates that could provide an inexpensive solution to this disease for poorer regions that may not be able to afford the expensive solutions of the pharmaceutical industry.
Thank you, this is interesting, I hadn't heard of its use In COVID.
But there are quite a few articles. Here is a list that I found through the iCite database. Sorry it's a crude printout. But you can see the titles, and usually Google them for more information. I usually put the title (or part of it) in quotation marks.
List of titles:
Repurposing Quinoline and Artemisinin Antimalarials as Therapeutics for SARS-CoV-2: Rationale and Implications.
Repurposing Anti-Malaria Phytomedicine Artemisinin as a COVID-19 Drug.
Modeling of SARS-CoV-2 Treatment Effects for Informed Drug Repurposing.
Determinants of Antimicrobial Use for Covid-19 Related Symptoms among Nigerians.
Novel and Controversial Therapies in COVID-19.
Artemisia annua L. extracts inhibit the in vitro replication of SARS-CoV-2 and two of its variants.
Antiviral and Immunomodulation Effects of Artemisia.
Artemisia annua L. extracts inhibit the in vitro replication of SARS-CoV-2 and two of its variants
Modeling of SARS-CoV-2 treatment effects for informed drug repurposing
Targeting TGF-b pathway with COVID-19 Drug Candidate ARTIVeda/PulmoHeal Accelerates Recovery from Mild-Moderate COVID-19
[Potential therapies for COVID-19 cardiovascular complications using artemisinin and its derivatives intervene based on its cardiovascular protection].
From hydroxychloroquine to ivermectin: what are the anti-viral properties of anti-parasitic drugs to combat SARS-CoV-2?
Cannabis sativa L. as a Natural Drug Meeting the Criteria of a Multitarget Approach to Treatment.
Re-reading ACT, BCG, and Low COVID-19 in Africa.
Chinese Medicine in Fighting against Covid-19: Role and Inspiration.
Maintaining focus on administering effective malaria treatment during the COVID-19 pandemic.
Treatment of COVID-19 with Chloroquine: Implication for Malaria Chemotherapy Using ACTs in Disease Endemic Countries.
Repurposing Antimalarials to Tackle the COVID-19 Pandemic.
Molecular screening of antimalarial, antiviral, anti-inflammatory and HIV protease inhibitors against spike glycoprotein of coronavirus.
Safety and efficacy of artemisinin-piperaquine for treatment of COVID-19: an open-label, non-randomised and controlled trial.
First principle study of silver nanoparticle interactions with antimalarial drugs extracted from Artemisia annua plant.
Molecular detection of drug resistant polymorphisms in Plasmodium falciparum isolates from Southwest, Nigeria.
Evaluation of the clinical performance of single-, dual-, and triple-target SARS-CoV-2 RT-qPCR methods.
Molecular detection of drug resistant polymorphisms in Plasmodium falciparum isolates from Southwest, Nigeria.
Hypoproteinemia is an independent risk factor for the prognosis of severe COVID-19 patients.
In vitro efficacy of Artemisinin-based treatments against SARS-CoV-2
The whole list was too big for a Blogger comment. Here's part 2:
Pandemics and Traditional Plant-Based Remedies. A Historical-Botanical Review in the Era of COVID19.
Antimicrobial mouthwashes (gargling) and nasal sprays administered to patients with suspected or confirmed COVID-19 infection to improve patient outcomes and to protect healthcare workers treating them.
Rudolf Bauer: China anti-COVID-19 success is closely related with the role TCM played.
Hydroxychloroquine: balancing the needs of LMICs during the COVID-19 pandemic.
Molecular docking analysis of Withaferin A from Withania somnifera with the Glucose regulated protein 78 (GRP78) receptor and the SARS-CoV-2 main protease.
Antimalarial artemisinin-based combination therapies (ACT) and COVID-19 in Africa: In vitro inhibition of SARS-CoV-2 replication by mefloquine-artesunate.
Anti-SARS-CoV-2 Potential of Artemisinins In Vitro.
First Principle Study of Silver Nanoparticles Interactions with Antimalarial Drugs Extracted from Artemisia Annua Plant
Is the traditional Chinese herb "Artemisia annua" possible to fight against COVID-19?
Antimalarial-agent artemisinin and derivatives portray more potent binding to Lys353 and Lys31-binding hotspots of SARS-CoV-2 spike protein than hydroxychloroquine: potential repurposing of artenimol for COVID-19.
Clinical and biological data on the use of hydroxychloroquine against SARS-CoV-2 could support the role of the NLRP3 inflammasome in the pathogenesis of respiratory disease.
Artesunate: could be an alternative drug to chloroquine in COVID-19 treatment?
Comparative Docking Studies on Curcumin with COVID-19 Proteins
Mass intake of hydroxychloroquine or chloroquine in the present context of the Covid-19 outbreak: Possible consequences in endemic malaria settings.
Anti-malarial drug, artemisinin and its derivatives for the treatment of respiratory diseases.
Phytocompounds of Rheum emodi, Thymus serpyllum and Artemisia annua inhibit COVID-19 binding to ACE2 receptor: In silico approach
Plant Solutions for the COVID-19 Pandemic and Beyond: Historical Reflections and Future Perspectives.
Artemisia annua: Trials are needed for COVID-19.
Anti-malarial drug, artemisinin and its derivatives for the treatment of respiratory diseases.
Anti-malarial drug, artemisinin and its derivatives for the treatment of respiratory diseases.
Guidance for the management of adult patients with coronavirus disease 2019.
Is Coronavirus Disease 2019 (COVID-19) seen less in countries more exposed to Malaria?
Diagnosing malaria and other febrile illnesses during the COVID-19 pandemic.
COVID-19 therapeutic options for patients with kidney disease.
Existing bitter medicines for fighting 2019-nCoV-associated infectious diseases.
In-silico Studies of Antimalarial-agent Artemisinin and Derivatives Portray More Potent Binding to Lys353 and Lys31-Binding Hotspots of SARS-CoV-2 Spike Protein than Hydroxychloroquine: Potential Repurposing of Artenimol for COVID-19.
Repurposing antimalarials and other drugs for COVID-19.
Preparedness is essential for malaria-endemic regions during the COVID-19 pandemic.
Discovery of Anti-2019-nCoV Agents from 38 Chinese Patent Drugs toward Respiratory Diseases via Docking Screening
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