Using double duty drugs-COVID-19, migraine, and shingles

In 2020 SARS-CoV-2 caused a worldwide pandemic of infection. To treat this novel, or new, virus, infectious disease experts turned to old drugs while developing new unique drugs to treat it.

In this post I’m reviewing some drugs that treat multiple conditions. This post was updated August 5, 2020.

Many drugs originally developed to prevent or treat one condition can be “repurposed” to treat another.

This information is current as of the publication date; it is general medical information that helps a doctor and patient make decisions about what is right for her. Medical recommendations and practice changes as we learn new things. If you deal with any of these issues , please discuss with your doctor before taking any action.

Centers for Disease Control and Prevention (CDC) activated its Emergency Operations Center (EOC) to coordinate with the World Health Organization (WHO), federal, state and local public health partners, and clinicians in response to the coronavirus disease 2019 (COVID-19) outbreak. CDC is closely monitoring the situation and working 24/7 to provide updates.
Centers for Disease Control and Prevention (CDC) activated its Emergency Operations Center (EOC) to coordinate with the World Health Organization (WHO), federal, state and local public health partners, and clinicians in response to the coronavirus disease 2019 (COVID-19) outbreak. CDC is closely monitoring the situation and working 24/7 to provide updates credit James Gathany, public domain

Treatment options for COVID-19

In 2020 SARS-CoV-2 caused a worldwide pandemic of infection. To treat this novel, or new, virus, infectious disease experts turned to old drugs while developing new unique drugs to treat it.

Chloroquine, an old malaria drug and its cousin hydroxychloroquine, used for rheumatoid arthritis and lupus received EUA, Emergency Use Authorization, from the FDA for use against COVID-19. At first it looked promising; President Trump even took it for prevention. But analysis of treatment results did not show fewer deaths but did find adverse heart effects so the EUA was withdrawn. However clinical trials using the drug can be continued.

In early July a hospital in Michigan released statistics showing more patients treated with hydroxychloroquine lived that those who weren’t, surprising other medical centers who did not find the same results in their patients.

As of August 2, 2020, the White House coronavirus task force member charged with coordinating the U.S. testing effort said that the nation needs to “move on” from the debate over hydroxychloroquine.  

Adm. Brett Giroir, assistant secretary of health and human services, said on NBC News’ “Meet the Press” that “from a public health standpoint, at first, hydroxychloroquine looked very promising” but at “this point in time, there’s been five randomized control, placebo-controlled trials that do not show any benefit to hydroxychloroquine.” 

“So, at this point in time, we don’t recommend that (hydroxychloroquine) as a treatment. There’s no evidence to show that it is,”

Adm. Brett Giroir

Another old drug however did reduce deaths in severely ill COVID-19 patients. Dexamethasone, a steroid, reduced mortality in patients who needed oxygen, either alone or by a ventilator and is now recommended for use in all such patients. Steroids treat a variety of conditions including severe asthma, rheumatoid arthritis, gout, lupus, autoimmune diseases, and multiple other inflammatory conditions.

illustration showing the coronavirus which causes COVID-19

 

Avoiding surgery for ectopic pregnancy

Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus. As the fertilized egg begins developing into an embryo, it will eventually outgrow size of the Fallopian tube, and rupture, causing hemorrhage (bleeding) in the pregnant woman.

Ruptured ectopic pregnancies cause about 2.7% of pregnancy-related deaths. Ectopic pregnancy is a true medical emergency and usually requires surgery to prevent death. But another old medicine can in some cases spare a woman from losing her tube to either rupture or surgery.

Methotrexate is an old drug used to treat several forms of cancer as well as several inflammatory and autoimmune diseases, including psoriasis, multiple sclerosis, and Crohn’s Disease. Now, some patients can avoid surgery for an ectopic pregnancy by receiving one or two doses of methotrexate by the IM (intra-muscle) injection route.

The treatment is not 100% effective; patients must follow their doctor’s instructions for follow up carefully, as surgery may still be necessary.

https://medlineplus.gov/images/femalereproductivesystem.png

Prevention of migraine pain and disability

Migraine, although not exclusive to women,occurs much more frequently in them than men. For infrequent headaches,non opiate pain relievers are effective and recommended. But for severe, frequent, or persistent symptoms prevention is recommended to improve quality of life.

Botox, onabotulinumtoxin A, has been FDA approved for treating chronic migraine, meaning patients with frequent headaches and other migraine symptoms for at least 3 months.

Yes the same drug used to treat wrinkles,Botox, can prevent migraine.

Manufactured by Allergan, a vial containing 200 units costs $1452, per goodrx.com. For migraine, the drug is injected in the upper facial muscles by a physician specifically trained in its use.

 

Preventing cancers with the HPV vaccine

Infection with the HPV, human papillomavirus, causes genital warts, an uncomfortable condition but not life threatening. However it can also cause changes in the cervix called CIN which can lead to cervical cancer.

According to a review of clinical trials by Cochran, vaccination against this virus effectively prevents infection and thus fewer cases of CIN. Since a significant percentage of CIN progresses to cancer, we can expect fewer women will develop invasive cervical cancer, the 4th most common cancer in women worldwide.

The vaccine, Gardasail 9, originally approved for use in females ages 9 to 26 years,received FDA approval for use up to ages 17 to 45 years in both males and females.

The vaccine is intended to prevent cancers of the anus, vulva, vagina, and cervix.

The American Cancer Society, ACS, recommends routine vaccination from ages 9-12 years, to prevent the greatest number of cancers, since the vaccine is less effective at older ages. The ACS encourages physicians to offer “catch-up” vaccination to people through age 26 years. For persons older than 26 years, the vaccine offers much less cancer prevention so the society does not recommend it.

HPV-16 E5 Oncoprotein
Description:
A koilocyte is a squamous epithelial cell that has undergone structural changes as a result of infection by human papillomavirus (HPV). This image of a koilocyte shows human ectocervical cells (HEC) expressing HPV-16 E5 oncoprotein, and immortalized with HPV-16 E6 and E7 oncoproteins. Formation of koilocytes requires cooperation between HPV E5 and E6 oncoproteins. The cell culture is stained with hematoxylin and eosin (H&E).

This image was originally submitted as part of the 2016 NCI Cancer Close Up project.

This image is part of the NCI Cancer Close Up 2016 collection.


Source:
National Cancer Institute \ Georgetown Lombardi Comprehensive Cancer Center
Creator:
Ewa Krawczyk
Date Created:
2006
Date Added:
April 11, 2016
Reuse Restrictions:
None – This image is in the public domain and can be freely reused. Please credit the source and, where possible, the creator listed above.

Stopping shingles-and strokes- with the zoster vaccine

Zoster is a reactivation of the varicella/zoster virus that causes chickenpox. It causes a painful rash known as shingles;the pain may continue after the rash is gone. It can happen at any age, but symptoms tend to be worst in older persons.

The new zoster (shingles) vaccine, Shingrix, prevents the painful rash much more effectively than the original vaccine Zostavax. It ranges in effectiveness from 91% to 97% at preventing shingles, depending on age. The first vaccine was 51% effective.

However, the original shingles vaccine may not prevent shingles as well, but it may prevent strokes due to inhibiting inflammation causes by the shingles virus.

Researchers at the CDC reviewed the Medicare health records of more than 1 million people age 66 or older who received Zostavax between 2008 and 2014, and 1 million people of the same age who had not received the vaccination. Researchers took into account age, gender, race, medications and existing health conditions.

Based on these records, the Zostavax reduced stroke risk by 18% for the most common type of stroke. During the years they reviewed, the Shingrix was not in use, so they couldn’t say if it would also show a protective effect.

Signs of Stroke
Signs of Stroke

Stroke is the fifth leading cause of death in the U.S. and causes more serious long-term disabilities than any other disease. Every minute counts, especially during the COVID-19 crisis. The best way to help someone having a stroke is to recognize the symptoms and call 9-1-1. www.stroke.nih.gov/index.htm
before you leave, here’s another post you might enjoy

exploring the HEART of health

Thanks for joining me to review some old drugs with new tricks.

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

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                              Dr. Aletha 

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Why COVID-19 and other infections are not “just a virus”

Unless you haven’t listened to any news for the past 8 weeks, you are well aware of the “challenge” the whole world has been confronting over what some do call “just a virus”; and you know that it has caused much critical illness and death, leading to “public” and private anxiety.

” In a very short period, health care and society have been severely challenged by yet another emerging virus. Preventing transmission and slowing the rate of new infections are the primary goals.

However, the concern of COVID-19 causing critical illness and death is at the core of public anxiety.”

JAMA, March 11, 2020 “Care for Critically Ill Patients with COVID-19”
“just a virus”

You’ve probably visited your doctor or your child’s doctor for an acute illness that started suddenly or over a few days. Likely the symptoms included some combination of

  • fever and/or chills
  • sore throat, runny nose, and/or sneezing
  • cough
  • joint and/or muscle aches
  • vomiting with or without diarrhea
  • rash
  • redness with or without drainage from the eyes
  • headache and a general miserable feeling
This illustration depicted a 3D computer-generated rendering of a whole influenza (flu) virus with a light grey surface membrane, set against a white background. The virus’ surface proteins, hemagglutinin (HA) and neuraminidase (NA), were depicted in light and dark blue, respectively. HA is a trimer, which is comprised of three subunits, while NA is a tetramer, which is comprised of four subunits, with a head region resembling a 4-leaf clover. CDC/ Douglas Jordan, public domain

And you were probably told that you or your child had “a virus”,or viral infection, followed by one or more of the following phrases-

  • there is no treatment but it will go away
  • the treatment will not cure it, but it will help the symptoms
  • it has to run it’s course
  • it resolves without treatment
  • you caught it from someone else
  • it is contagious
  • the symptoms will go away, but it stays in your body
  • you may get it again
  • you won’t get it again
  • there is a vaccine to prevent this
  • there is no vaccine to prevent this
This image depicted a Centers for Disease Control and Prevention (CDC) scientist interacting with her Caliper LifeSciences’ Zephyr Molecular Biology Workstation, working with samples to be tested using a real-time PCR machine, known as a themocycler (see PHIL 22904), in order to identify the various types of poliovirus contained therein. The data from this analysis is stored in a computer, while the software further analyzes the data before being reviewed by a scientist. The themocycler can vary the temperature, which is important, for PCR requires multiple test rounds at different temperatures. In the instrument, viral RNA is copied into DNA and then the DNA is amplified. Specific probes bind to the DNA, in order to determine what type of polio present. One hundred ten labs around the world can run this assay, and can tell if an isolate contains polio, or not, and if so, what kind.CDC/ Holly Patrick, MS, MPH

And finally, you may have heard a phrase I hope you never hear, and I hope we doctors never use again-

“It’s JUST a virus.”

Why it’s never “just a virus”

The quote at the beginning of this post is from an article in the Journal of the AMA . Unless you haven’t listened to any news for the past 8 weeks, you are well aware of the “challenge” the whole world has been confronting over what some do call “just a virus”; and you know that it has caused much critical illness and death, leading to “public” and private anxiety.

But we shouldn’t have been surprised. Viruses have been around probably as long as humans have, we just didn’t know much about them until the past century or so. After all, viruses are made of genetic material DNA or RNA, like us and animals; when viral DNA/RNA invades our bodies and enters our cells, they start reproducing (replicating), causing disease. (This is a simplified explanation of what viruses do.)

Transmission electron microscopic image of an isolate from the first U.S. case of COVID-19, formerly known as 2019-nCoV. The spherical viral particles, colorized blue, contain cross-sections through the viral genome, seen as black dots.CDC/ Hannah A Bullock; Azaibi Tamin
How do doctors know it’s a virus?

Until fairly recently, viral infections were diagnosed by typical symptoms and characteristic physical exam findings, especially fever and rash, and many are still diagnosed that way. Then laboratory scientists developed tests for some viruses, which help confirm the diagnosis , important when a treatment is available. The tests can also be used to know if someone is or is not already immune to a disease, if a vaccine is available.

So what infections are caused by viruses?

Lots of them are, but fortunately most are not nearly as serious as the novel coronavirus that causes COVID-19, or the 2 previous coronavirus outbreaks, SARS and MERS. You’re probably quite familiar with some of them. Here’s what I think is an easy to understand way to categorize them.

This illustration provides a 3-dimensional (3D) graphical representation of a tightly packed, icosahedral, poliovirus particle that consists of 60-copies each of capsid polypeptides, designated as pink VP1 (viral protein1), green VP2, purple VP3, and though not shown here, VP4. This particle was composed of units of four capsid polypeptides, which interact in groups of five, resulting in a viral particle that has, what is referred to as 5-fold (pentameric), and 12-fold symmetry. Note the deep canyon on the capsid’s surface surrounding the apex of each pentamer of the virus. The canyon, together with the pentamer apex, is used as the site for capsid binding to cellular receptors.CDC/ Sarah Poser

categories of viral infections

This is how they behave without previous vaccination or treatment (when available) .This is not an exhaustive list, just some of the most common. These all spread person to person.

Short duration, followed by life-long immunity
  • measles
  • mumps
  • rubella
  • polio
  • hepatitis A
Short duration, followed by short-lived immunity
  • RSV- respiratory syncytial virus
  • influenza
  • rhinovirus (common cold)
  • coronavirus
Persistent infection, life-long carrier of virus, virus inactive at times, not always passed to other people
  • HSV-herpes simplex virus
  • VZ-varicella/zoster (chicken pox-shingles)
Persistent infection, life-long carrier of virus, virus always active and can be passed to other people
  • HIV/AIDS-human immunodeficiency virus
  • Hepatitis B
  • Hepatitis C
  • HPV-human papilloma virus
Viruses that spread from animals to humans
  • Avian influenza
  • Rabies
  • West Nile virus
Viruses that spread from animals to humans-and sometimes then to other humans
  • yellow fever
  • coronavirus
  • Ebola
Centers for Disease Control and Prevention (CDC) activated its Emergency Operations Center (EOC) to assist public health partners in responding to the coronavirus disease 2019 (COVID-19) outbreak first identified in Wuhan, China.
How serious are viral infections?

How serious a viral infection is depends on how you want to define “serious”. Even a “mild” illness can be a major problem if it’s you or your family that is sick. With a mild illness, you still may feel too sick to work or go to school, which you should not do anyway, so not to transmit it to other people.

The above classification is quite simplified, a framework for looking at infections that you’ve probably heard of. They range from the common cold, with no risk of death, to HIV/AIDS and rabies, which are always fatal without treatment.

People with the short duration infections usually recover but some carry risk of progressing into life threatening respiratory events, due to RSV, influenza, and now the coronaviruses. Polio frequently left its victims paralyzed for life and measles can cause permanent deafness.

The herpes virus and VZ virus cause recurrent outbreaks of painful skin sores. . Hepatitis B and C viruses can lead to chronic liver disease and liver cancer. HPV causes benign warts but also cancer of the cervix.

This illustration, created at the Centers for Disease Control and Prevention (CDC), reveals ultrastructural morphology exhibited by coronaviruses. Note the spikes that adorn the outer surface of the virus, which impart the look of a corona surrounding the virion, when viewed electron microscopically. In this view, the protein particles E, S, and M, also located on the outer surface of the particle, have all been labeled as well. A novel coronavirus, named Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), was identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China in 2019. The illness caused by this virus has been named coronavirus disease 2019 (COVID-19).CDC/ Alissa Eckert, MS; Dan Higgins, MAMS
“the challenge of emerging virus”

I hope that we all learn from this pandemic. I hope both physicians and patients take viral infections more seriously and appreciate the complexity and challenge they represent. We share something important with them-DNA, the genetic material that creates health as well as disease. Viruses aren’t static; like us they change and adapt.

We have vaccines that can dramatically reduce our risk of getting several of these diseases and I hope more people will use them. We have a few drugs which combat these diseases; fortunately some have been life saving, like those for HIV/AIDs.

Healthy lifestyles offer protection against infections of all kinds but we frequently overlook their value. You may be tired of hearing them but they include

  • hand washing- often and thoroughly
  • cleaning and disinfecting frequently touched surfaces
  • water and sanitation facilities
  • safe food handling and cooking practices
  • wise sexual practices
  • staying home when sick
  • limiting contact with animals and preventing insect bites
  • immunization

sharing the HEART of health

For this post I reviewed sections of the textbook Fenner and White’s Medical Virology, Fifth Edition , made available online free at ScienceDirect.com specifically to help medical professionals navigate the COVID-19 challenge.

You might want to check out some less technical references at these links.

Overview of Viral Infections

Viral Infection

Except for the cover photo, the pictures in the post are from the Centers for Disease Control and Prevention website, and are in the public domain.

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

                              Dr. Aletha