Hydroxychloroquine is used to prevent or treat malaria infections caused by mosquito bites. It does not work against certain types of malaria.
Table of contents
- Drug spotlight on hydroxychloroquine
- Hydroxychloroquine - Side Effects, Dosage, Interactions - Drugs - Everyday Health
- Before taking hydroxychloroquine
- What kind of medicine is hydroxychloroquine?
These lysosomotropic effects occur in macrophages , dendritic cells , and lymphocytes. Hydroxychloroquine has a two-fold impact on T cells. The combined effect is a beneficial action in autoimmunity without a penalty of increased opportunistic infections. Antiproliferative and immunomodulatory effects are mediated by decreasing lymphocyte proliferation , interference with natural killer cell activity, and possibly the alteration of auto- antibody production.
The photoprotective effects of hydroxychloroquine are not entirely understood. Current theories include that the:. Antimalarial medications prevent platelet aggregation and act as prostaglandin antagonists due to the inhibition of phospholipase A2. Therefore, hydroxychloroquine may be used as a life-long therapy for patients with systemic lupus who are at an increased risk of cardiovascular disease.
Hydroxychloroquine should be taken with a meal or a glass of milk to minimise the gastrointestinal side effects. Alternate-day dosing can be used. If a therapeutic response is not achieved with hydroxychloroquine alone, adding quinacrine may improve the therapeutic effect. For the treatment of cutaneous lupus erythematosus , the usual dose range is — mg daily until a therapeutic response is achieved. Although maximum doses were previously calculated on the patient's ideal body weight and advised not to exceed 6.
To minimise the cumulative dose, which is also believed to be of some importance in the development of retinal toxicity, the dose should be reduced as tolerated over the winter months. Initial higher doses may lead to hepatotoxicity as a result of rapid mobilisation of hepatic porphyrin stores.
Drug spotlight on hydroxychloroquine
The high affinity for melanin-containing cells such as those found in the retinal pigment epithelium is hypothesised to be the cause. The risk of retinal toxicity is dependent on several factors:. In , with new scientific data, the American Academy of Ophthalmology revised the screening recommendations for patients being commenced on long-term hydroxychloroquine therapy.
A fundus examination alone is insufficient for screening, and further tests are required including at least automated visual field testing and spectral-domain optical coherence tomography. Every patient should undergo a baseline ophthalmic examination within the first year of commencing hydroxychloroquine if long-term use is anticipated.
In the absence of risk factors listed above, annual screening should then be performed after five years. Patients with hydroxychloroquine-induced retinal toxicity will not have any visual symptoms in the early stages, and will only develop clinical symptoms with severe end-stage damage. Therefore, it is essential that the screening recommendations outlined above are followed, and hydroxychloroquine should be ceased if there are signs of definite retinopathy.
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The retinopathy does not reverse, but the progression is rare after hydroxychloroquine is discontinued. Visual symptoms may present as paracentral scotomas islands of vision loss when reading. If blurring or vision changes occur, hydroxychloroquine should be ceased, and a careful eye examination conducted. Nausea, vomiting, and diarrhoea are common side effects, but are usually transient or resolve on the reduction of the dose.
They can be minimised by taking the hydroxychloroquine with food. Transverse pigmented nail bands and mucosal pigmentation have also been reported. If a rash appears, hydroxychloroquine should be withdrawn and may be restarted at a lower dose. Haematological side effects are rare. Haemolysis in patients with glucosephosphate dehydrogenase G6PD deficiency, aplastic anaemia , and leukopenia has been reported.
The most extensive study to date evaluating G6PD deficiency with concurrent use of hydroxychloroquine reported no episodes of haemolysis in over months of exposure among the 11 studied patients with G6PD deficiency. Routine screening for G6PD deficiency is no longer recommended for hydroxychloroquine. Hydroxychloroquine does cross the placenta and is considered Category D in pregnancy see DermNet NZ's pages on Safety of medicines taken during pregnancy and on Lactation and the skin.
Hydroxychloroquine - Side Effects, Dosage, Interactions - Drugs - Everyday Health
Before taking hydroxychloroquine
How is it taken? Hydroxychloroquine is taken in tablet form, with or after food. How long does it take to work? Because it's a long-term treatment it's important to keep taking hydroxychloroquine unless you have severe side effects: even if it doesn't seem to be working at first even when your symptoms improve to help keep the disease under control. Side effects and risks Side effects aren't common. However, in some people hydroxychloroquine can cause: skin rashes, especially those made worse by sunlight feeling sick nausea or indigestion diarrhoea headaches bleaching of the hair or mild hair loss tinnitus ringing in the ears visual problems.
You should report any new eye symptoms to your doctor straight away. Effects on other treatments Hydroxychloroquine is commonly used alongside other disease-modifying drugs including methotrexate — especially for rheumatoid arthritis. You can carry on taking a non-steroidal anti-inflammatory drug NSAID or painkillers , if needed, unless your doctor advises otherwise. Don't take over-the-counter preparations or herbal remedies without discussing this first with your healthcare team. Vaccinations You can have vaccinations, including live vaccines such as yellow fever and shingles, while you're on hydroxychloroquine.
Hydroxychloroquine is widely used in the treatment of post-Lyme arthritis. It may have both an anti- spirochaete activity and an anti-inflammatory activity, similar to the treatment of rheumatoid arthritis. The drug label advises that hydroxychloroquine should not be prescribed to individuals with known hypersensitivity to 4-aminoquinoline compounds. The most common adverse effects are a mild nausea and occasional stomach cramps with mild diarrhea. The most serious adverse effects affect the eye, with dose-related retinopathy as a concern even after hydroxychloroquine use is discontinued.
For prolonged treatment of lupus or rheumatoid arthritis , adverse effects include the acute symptoms, plus altered eye pigmentation, acne , anemia , bleaching of hair, blisters in mouth and eyes, blood disorders, convulsions, vision difficulties, diminished reflexes, emotional changes, excessive coloring of the skin, hearing loss, hives, itching, liver problems or liver failure , loss of hair , muscle paralysis, weakness or atrophy , nightmares, psoriasis , reading difficulties, tinnitus , skin inflammation and scaling, skin rash, vertigo , weight loss , and occasionally urinary incontinence.
Children may be especially vulnerable to developing adverse effects from hydroxychloroquine. One of the most serious side effects is retinopathy generally with chronic use.
What kind of medicine is hydroxychloroquine?
The daily safe maximum dose for eye toxicity can be computed from one's height and weight using this calculator. Cumulative doses can also be calculated from this calculator. Macular toxicity is related to the total cumulative dose rather than the daily dose. Regular eye screening, even in the absence of visual symptoms, is recommended to begin when either of these risk factors occurs. Toxicity from hydroxychloroquine may be seen in two distinct areas of the eye: the cornea and the macula.
The cornea may become affected relatively commonly by an innocuous cornea verticillata or vortex keratopathy and is characterized by whorl-like corneal epithelial deposits. These changes bear no relationship to dosage and are usually reversible on cessation of hydroxychloroquine. The macular changes are potentially serious. Advanced retinopathy is characterized by reduction of visual acuity and a "bull's eye" macular lesion which is absent in early involvement.
Due to rapid absorption, symptoms of overdose can occur within a half an hour after ingestion.
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Overdose symptoms include convulsions, drowsiness, headache, heart problems or heart failure , difficulty breathing and vision problems. Hydroxychloroquine overdoses are rarely reported, with seven previous cases found in the English medical literature. Treatment consisted of fluid boluses and dopamine, oxygen, and potassium supplementation. The presence of hydroxychloroquine was confirmed through toxicologic tests. The patient's hypotension resolved within 4.
The drug transfers into breast milk and should be used with care by pregnant or nursing mothers. Care should be taken if combined with medication altering liver function as well as aurothioglucose Solganal , cimetidine Tagamet or digoxin Lanoxin. HCQ can increase plasma concentrations of penicillamine which may contribute to the development of severe side effects.