By Rafael Castillo M.D.
Some of my patients have been inquiring about the newly approved traditional Chinese medicine (TCM) Lianhua Qingwen (LQ) as an herbal treatment for the new coronavirus disease (COVID-19).
The TCM drug has been flooding the black market since the start of the pandemic, being directly sold by nonphysicians in villages and offices. It’s being promoted for mild to moderate COVID-19.
Even before it was approved by the Philippine Food and Drug Administration (FDA) recently, doctors were being given generous samples which they may give their patients. The FDA even issued an advisory on May 6 warning the public against the use of this product, which had not been evaluated properly then. Finally, this month, the FDA greenlighted the product via the TCM pathway.
It’s to be recalled that the US FDA also issued a stern warning to the manufacturer for making therapeutic claims against COVID-19. Health Canada also approved the herbal product, but advised against claiming it could treat COVID-19.
To be fair to this product, it’s not true that it has no scientific basis at all. There are a few small open clinical trials, considered low-quality data, showing that LQ, combined with conventional drugs used for COVID-19, provided faster relief of main symptoms (fever, cough, fatigue), as well as other symptoms (chest tightness, dyspnea and loss of appetite).
However, since the data is subject to a lot of bias and is of low quality, the authors suggested that better designed clinical trials—bigger-sized, multicenter, randomized, double-blind, controlled trials—be done to validate what has been observed in the published preliminary trials.
The Therapeutics and Medication Safety Committee of Makati Medical Center (MMC), chaired by Dr. Lourdes Dorion-Diaz, issued an advisory a few days ago that LQ contains Ma Huang, a weed from which ephedra (ephedrine) is extracted. The advisory, which was also signed by MMC director Dr. Saturnino Javier, warned that ephedrine is classified by our Dangerous Drug Board as a dangerous drug, which must only be prescribed by physicians with a special license (S2) for such products.
Contraindications for ephedra
Ephedrine may be risky to use for patients with heart problems, high blood pressure, fast or irregular heartbeat. It’s a stimulant, promotes constriction of arteries and blood vessels restricting blood flow, and given to the wrong patient with cardiovascular issues, it can potentially trigger a heart attack, stroke or even sudden death.
The FDA should strongly warn against the direct sale of LQ, which is even promoted by some as a “vitamin” to boost the immune system, or as a prophylactic drug to prevent COVID-19. Both of these claims are baseless. It should be made a prescription product, and as recommended by the MMC advisory, should only be prescribed by physicians, ideally with an S2 license.
Ephedra can also have serious interactions with other drugs which heart patients commonly take, so it’s best that they get the clearance of their physicians to prevent unpleasant and potentially serious complications.
So, in short, LQ is not a vitamin, nor can it boost the immune system; is not a totally harmless supplement that may be taken without doctor’s supervision, particularly in the elderly, hypertensive, diabetic, in those with history of stroke, heart attack or other chronic medical conditions; should not be taken for prophylaxis and prevention of COVID-19; should not be taken for asymptomatic COVID-19; has no antiviral properties and does not kill the virus causing COVID-19; and should only be taken with doctor’s advice and prescription. If there are no contraindications to its use and one has COVID-19 symptoms, however, it may help relieve symptoms and shorten recovery time in mild to moderate COVID-19.