This is an official
CDC HEALTH ADVISORY
Distributed via the CDC Health Alert Network
March 28, 2020, 11:00 AM ET
Severe Illness Associated with Using Non-Pharmaceutical Chloroquine Phosphate
to Prevent and Treat Coronavirus Disease 2019 (COVID-19)
Chloroquine phosphate, when used without a prescription and supervision
of a healthcare provider, can cause serious health consequences, including
death. Clinicians and public health officials should discourage the public
from misusing non-pharmaceutical chloroquine phosphate (a chemical used
in home aquariums). Clinicians should advise patients and the public that
chloroquine, and the related compound hydroxychloroquine, should be used
only under the supervision of a healthcare provider as prescribed medications.
The Centers for Disease Control and Prevention (CDC) has become aware of
two individuals who ingested non-pharmaceutical chloroquine phosphate,
a chemical for aquarium use that is commercially available for purchase
at stores and through internet websites. One of the individuals died shortly
after arrival to the hospital. The second individual was critically ill
with severe gastrointestinal symptoms and cardiac conduction abnormalities.
Upon recovery, the surviving individual reported to the media that they
ingested the product to prevent infection with SARS-CoV-2, which causes
coronavirus disease 2019 (COVID-19), after seeing information on the medical
use of chloroquine on television. The product in their possession was
in powder form inside a 2.2-lb. container and labeled “for Ornamental
Fish Use Only”. CDC is also aware of unconfirmed media reports that
these commercially available aquarium-use chemicals may be out of stock
due to potential increased demand by the public.
At this time, there are no routinely available pharmaceutical products
that are FDA-approved for the prevention or treatment of COVID-19. Pharmaceutical
chloroquine phosphate and hydroxychloroquine sulfate are approved by the
US Food and Drug Administration (FDA) to treat specific medical conditions,
such as malaria, lupus, and rheumatoid arthritis. Currently, these medications
are being studied and evaluated as treatment for COVID-19; however, their
efficacy to either prevent or treat this infection are unknown. In overdose
situations or when used inappropriately, these medications can lead to
severe toxicity, including cardiac rhythm disturbances such as prolonged
QT, severe hypokalemia, cardiovascular collapse, seizures, coma, and death.
Inappropriate uses include taking commercially available non-pharmaceutical
preparations, taking chloroquine phosphate or hydroxychloroquine sulfate
without a prescription, and taking additional doses not recommended by
a healthcare provider. Chloroquine phosphate has a narrow therapeutic
index—it can be toxic at levels not much higher than those used
for treatment—which raises the risk of inadvertent overdose.
Recommendations for Clinicians and Public Health Officials
- Educate patients on the serious risks of misusing non-pharmaceutical chloroquine
products and other aquarium use chemicals.
- Counsel your patients on the importance of taking medications only as prescribed
and as directed by healthcare providers.
- Contact your local poison center (1-800-222-1222) to report cases and to
obtain specific medical management of chloroquine and hydroxychloroquine
- Adverse events related to pharmaceuticals can be reported to the FDA MedWatch
Adverse events related to non-pharmaceutical products can be reported
by emailing FDA-COVID-19- Fraudulent-Products@fda.hhs.gov or calling 1-888-InfoFDA
Recommendations for the Public
not ingest aquarium use products or any other chemicals that contain chloroquine
phosphate. These chemicals are not intended for human consumption and
can lead to serious health consequences, including death.
- Medications like chloroquine phosphate and hydroxychloroquine sulfate should
be taken only when prescribed by and under the supervision of your healthcare
provider and always according to the instructions provided.
- Seek immediate medical attention if you are experiencing any unexpected
symptoms after taking chloroquine or hydroxychloroquine by contacting
your healthcare provider or your poison center (1- 800-222-1222).
For More Information
- CDC coronavirus website (https://www.cdc.gov/coronavirus)
- U.S. Government coronavirus website (https://www.coronavirus.gov/)
- FDA Letter to Stakeholders (https://www.fda.gov/animal-veterinary/product-safetyinformation/fda-letter-stakeholders-do-not-use-chloroquine-phosphate-intended-fish-treatmentcovid-19-humans)
- Banner Health (Phoenix, AZ) press release (https://bannerhealth.mediaroom.com/chloroquinephosphate)
- Dailymed (https://dailymed.nlm.nih.gov/dailymed/index.cfm) for medical
- American College of Medical Toxicology (https://www.acmt.net) for poisoning
- Association of American Poison Control Centers (https://www.aapcc.org)
The Centers for Disease Control and Prevention (CDC) protects people's
health and safety by preventing and controlling diseases and injuries;
enhances health decisions by providing credible information on critical
health issues; and promotes healthy living through strong partnerships
with local, national, and international organizations.
Categories of Health Alert Network messages:
Health Alert Requires immediate action or attention; highest level of importance
Health Advisory May not require immediate action; provides important information for a
specific incident or situation
Health Update Unlikely to require immediate action; provides updated information regarding
an incident or situation
HAN Info Service Does not require immediate action; provides general public health information
##This message was distributed to state and local health officers, state
and local epidemiologists, state and local laboratory directors, public
information officers, HAN coordinators, and clinician organizations##