In a widely observed trend, Indians are now self-prescribing and popping medicines, which are generally given to Covid-19 patients in hospital settings, immediately after testing positive or showing symptoms of coronavirus infection.
According to doctors at prominent hospitals, these patients land up in hospitals in later stages and confess to consuming “popular” or “known Covid drugs” such as hydroxychloroquine (HCQ), ivermectin, doxycycline and dexamethasone to prevent “severe” disease.
“Out of every 10 Covid patients, four of them come up to hospitals after venturing with one or two of the medicines used in the treatment of Covid. All these medicines should be taken in the hospital settings, under a trained physician. We have seen that people mostly self-prescribe ivermectin and doxycycline,” said Dr Yatin Mehta, chairman, critical care department at Medanta Hospital, Gurugram.
Over the last year, these medicines came into spotlight as possible treatment options for Covid. However, as clinicians started getting clarity about the course of the treatment for the novel disease, the role of these medicines was either curtailed or fixed for a certain illness in a specific time period.
With the second Covid wave rampaging in India now and beds and ICUs running short, the paranoia over catching severe disease is leading people to try these drugs.
Echoing a similar trend, Dr Kamna Kakkar, senior resident, ICUs, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, said, “Half of the Covid patients end up confessing that they did consume one or the other drug used in the treatment of Covid. The top list includes HCQ, ivermectin, and dexamethasone.”
She added: “As soon as people start showing symptoms of Covid or test positive, they just Google and start gulping down the drugs without realising that they might end up complicating their treatment and recovery process. Moreover, the national treatment protocols are for doctors and not for patients.”
Not just Google, but some people also gulp these drugs on advice from private practitioners or doctors known to them.
Dr Amandeep, president of the resident doctors’ association at All India Institute of Medical Sciences in New Delhi, said, “These are generally patients with mild symptoms. Those we have encountered usually take these drugs based on the advice from the local doctors or read it on Google.”
How such self-prescriptions are harmful
Self-consumption of medicines, however, can affect the natural course of treatment and also lead to patients reporting additional side-effects (which are not due to Covid) leading to further complications in recovery, said Mehta.
A case in point is a 32-year-old woman at Apollo Gleneagles in Kolkata. Doctors assessed her condition only to understand that she had been taking dexamethasone — a powerful steroid — at home, without prescription. Her CT scan showed “worsened Covid” and she is now battling for life in the intensive care unit (ICU), said Dr Chandrashish Chakravarty, consultant, Critical Care Medicine, Apollo Gleneagles.
“Several of such patients reach the emergency departments on a daily basis. Fearing Covid, they start consuming popular Covid drugs at home. While drugs cause their own side-effects, the patients end up losing the important treatment time leading to severe Covid,” he said.
Amandeep explained, “The drug, as well as its duration, is specific for a specific illness. Taking treatment without prescription can be harmful. For instance: dexamethasone, which is a steroid, if taken for a long time can have harmful effects and can cause osteoporosis, immunosuppression, and deranged blood glucose. One needs to be very cautious in starting treatment on your own.”
Self-prescription of HCQ can be life-threatening as it may cause abnormal heart rhythms or dangerously rapid heart rate. Similarly, parasite drug ivermectin, according to the USFDA, has the potential to cause decrease in white cell count and elevated liver tests apart from causing other general side effects.
The US health regulator has also cautioned on its website to “not take any medicine to treat or prevent COVID-19 unless it has been prescribed to you by your health care provider and acquired from a legitimate source”.
Overload of information
Doctors are facing stress related to the massive information available online or in the public domain leading patients and their families to ask for a certain type of prescription.
“Every patient or their families talk about their Ct score. They all want us to prescribe remdesivir or favipiravir. It seems like everyone has become a doctor to treat Covid,” said Mehta, who has been working in the Covid ward at Medanta since last year.
“How should we clarify that Ct values have not been validated but it is Ct Severity Scores (CTSS) that can tell you about the severity,” he added.
Kakkar has seen her patients “consuming medicines that are mostly mentioned in the national treatment protocol, easily available online”.
“There is a lot of information available online. However, I would request patients and their families to trust their treating doctor. It is difficult for us to make everyone understand which treatment protocol is latest and which one is dated,” she said.