Just fact checking RB's extreme dislike of the internationally recognised and applauded UK RECOVERY trial (yes there are still some things we do right). RB said:
thousands of patients on 2400 mg/day is the Wreckovery study..
which incompetent pharmacist checked that dose....?? the routine dosing is 200-400 mg..
From the comments about that trial (more detail, agreeing with RB):
This article failed to mention that they used dangerous doses of HCQ. 2400mg in the first 24 hours and 9600mg in 10 days. Plenty of government agencies all over the world set the limit/day to 600mg. 4 times the limit
Malaria chock treatment is 800mg in the first day and 2000mg total in 48 hours. Because agencies know the half life of HCQ is 22 days.
The conclusion made is misguiding and should be changed.
But the thing is, a large initial dose is exactly expected given that the drug build up in the body over time, but for HCQ to be effective we all agree it should be started ASAP. The dosage tolerable over 10 days is much larger than the dosage tolerable over a longer period. See below for expert comment.
So RB (and the other guy) is comparing apples with pears. In fact the RECOVERY trial was upping the initial dose to give HCQ a chance and had they not done this RB et al would have pointed it out as a defect.
https://www.bmj.com/content/370/bmj.m2670
The high doses of hydroxychloroquine used in RECOVERY—800 mg at 0 and 6 hours followed by 400 mg at 12 hours and then every 12 hours for up to nine additional days—have raised concern among experts.
David Jayne, professor of clinical autoimmunity at Cambridge University, said that current recommended doses for rheumatologic disease are typically 300-400 mg/day and that the maximum dose for malaria has been 800 mg in the first 24 hours. “The reasons behind the dose selection in the RECOVERY trial are unclear,” he says. “Hydroxychloroquine overdose is associated with cardiovascular, neurological, and other toxicities, occurring with doses over 1500 mg, and higher doses are associated with fatality.” He is concerned that hydroxychloroquine toxicity may have contributed to the adverse outcomes and that conclusions based on these results may be unreliable.
Martin Landray, RECOVERY’s deputy chief investigator, says, “We did not choose these doses by accident. The dose comes from modelling by Nick White, professor of tropical medicine at the University of Oxford, and his team, who have extensive experience with this drug. They developed detailed pharmacokinetic models, considering the best way in which to rapidly achieve drug levels that might be high enough to kill the virus but not so high as to trigger toxicity. Their work has recently been published as a preprint on medRxiv.”