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Pharmaceutical companies must guarantee the supply of certain drugs considered essential and promptly report their available stock and production and distribution forecasts. This is established by an obligation of the Government contained in the BOE of March 24, which also contemplates the possibility of prioritizing the production of these drugs over others.

“The health crisis situation caused by Covid-19 makes it necessary to have up-to-date information on the actual availability and forecast of manufacture of certain medicines that are considered essential in this emergency. Likewise, to protect public health, it is unavoidable to guarantee the supply of these drugs in health centers and services, and this requires a daily distribution capable of covering consumption with the necessary agility, "reads the document, which establishes which drugs are considered essential. On that list are pain relievers like acetaminophen, antibiotics like amoxicillin, or hormones like insulin that diabetics need to live; but also some of the drugs that are being used in patients affected by the epidemic, such as tocilizumab, lopinavir / ritonavir or hydroxychloroquine , the drug that is being talked about the most in recent days.

Even Trump has mentioned in this controversial tweet that this drug, although known for decades, has become a promise - not without controversy - against the SARS-CoV-2 epidemic. "It is one of the drugs that are being used the most against Covid-19," confirms Olga Delgado, president of the Spanish Society of Hospital Pharmacy (SEFH).

The medicine is an old acquaintance for specialists, since it is used against malaria (although it has fallen into disuse due to the development of resistance) and, above all, in rheumatic diseases such as lupus and rheumatoid arthritis . But, in addition, it has begun to be considered as a treatment against the Wuhan coronavirus since, especially "in in vitro studies it has been shown to have an antiviral effect," confirms Delgado.

What made this drug famous was its experimental use in various Chinese hospitals during the outbreak and, above all, a study recently published by the French virologist Didier Raoult, which analyzed the case of 42 French patients admitted for SARS infection- CoV-2. Their conclusions suggested that hydroxychloroquine, especially in combination with azithromycin, could be an effective weapon against the epidemic, helping to control and shorten signs of the disease, such as pneumonia.

The study immediately received criticism for the small size of the analyzed sample and the methodological limitations of its design.

However, the expectations generated by the drug have led different countries, such as Italy, France, China and Spain to include it among the treatment alternatives for patients with Covid-19. The Spanish Agency for Medicines and Health Products (AEMPS) itself acknowledged a few days ago in a statement that the level of evidence on the usefulness of the drug "is still low and based on preclinical and safety data on other indications . " Its effectiveness "is being evaluated in a good number of clinical trials whose results have not been published at the moment."

"The results of the tests are not yet robust, but right now it is the most robust molecule we handle," says Delgado, who recalls that it is a product known and used for decades.

This increase in interest in hydroxychloroquine (and also in the chloroquine phosphate, from which the drug is derived) has caused the health authorities to decide to impose certain restrictions on its marketing. AEMPS started a controlled distribution of and a control of the available stock of the product a few days ago, which in Spain is marketed as Dolquine or Xanban, among others.

As stated by the agency in a statement, the available medication will be prioritized for the treatment of chronic patients; use in clinical trials and therapy of hospitalized patients with pneumonia. "It is not advisable to start treatments in other types of clinical situations outside the context of authorized clinical trials," the document stresses.

"Hydroxychloroquine is one of the most widely used drugs and by far the most promising," says Delgado, who recalls that the different available alternatives are often combined. For example, other options may be added to treatment with hydroxychloroquine, such as tocilizumab.

"Only in the case of the antiviral remdesivir is it indicated to withdraw all previous treatments," adds the specialist.

"We try to assess in each case which is the best option available and the protocols are updated day by day," he continues.

In his opinion, it is essential to control and rationalize the use of drugs that can be key for many patients. In this sense, it calls for not hoarding certain products that, although they must be purchased with a prescription, until now could be bought in conventional pharmacies.

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