Hydroxychloroquine sulfate tablets are not effective against chloroquine-resistant strains of P. Before starting a long-term treatment, both eyes should be carefully examined for visual acuity, central visual field, and color vision. Examination should also include fundoscopy. These examinations should be repeated at least annually.
Retinal toxicity is largely dose-related. The risk of retinal damage is small with daily doses of up to 6. Exceeding the recommended daily dose sharply increases the risk of retinal toxicity. This examination should be more frequent and adapted to the patient in the following situations:. If any visual disturbance occurs visual acuity, color vision , the drug should be immediately discontinued and the patient closely observed for possible progression of the abnormality.
What is hydroxychloroquine?
Retinal changes and visual disturbances may progress even after cessation of the therapy. Suicidal behavior has been reported in very rare cases in patients treated with hydroxychloroquine. Children are especially sensitive to the 4-aminoquinoline compounds. A number of fatalities have been reported following the accidental ingestion of chloroquine, sometimes in relatively small doses 0. Patients should be strongly warned to keep these drugs out of the reach of children.
When used in patients with porphyria the condition may be exacerbated. The preparation should not be used in these conditions unless in the judgment of the physician the benefit to the patient outweighs the possible hazard. Usage in Pregnancy- Usage of this drug during pregnancy should be avoided except in the suppression or treatment of malaria when in the judgment of the physician the benefit outweighs the possible hazard. It should be noted that radioactively-tagged chloroquine administered intravenously to pregnant, pigmented CBA mice passed rapidly across the placenta.
It accumulated selectively in the melanin structures of the fetal eyes and was retained in the ocular tissues for five months after the drug had been eliminated from the rest of the body. Antimalarial compounds should be used with caution in patients with hepatic disease or alcoholism or in conjunction with known hepatotoxic drugs. Periodic blood cell counts should be made if patients are given prolonged therapy. If any severe blood disorder appears which is not attributable to the disease under treatment, discontinuation of the drug should be considered.
The drug should be administered with caution in patients having GPD glucosephosphate dehydrogenase deficiency. Psychiatric disorders: Nervousness, emotional lability, psychosis, suicidal behavior. Eye disorders: Retinopathy with changes in pigmentation and visual field defects have been reported.
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In its early form, it appears reversible on discontinuation of hydroxychloroquine. If allowed to develop, there may be a risk of progression even after treatment withdrawal. Cases of maculopathies and macular degeneration have been reported and may be irreversible. Skin and subcutaneous tissue disorders: Bullous eruptions including very rare cases of Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, photosensitivity, and exfoliative dermatitis have been reported.
The 4-aminoquinoline compounds are very rapidly and completely absorbed after ingestion, and in accidental overdosage, or rarely with lower doses in hypersensitive patients, toxic symptoms may occur within 30 minutes. The symptoms of overdosage may include headache, drowsiness, visual disturbances, cardiovascular collapse, convulsions, hypokalemia, rhythm and conduction disorders including QT prolongation, torsade de pointe, ventricular tachycardia and ventricular fibrillation, followed by sudden potentially fatal respiratory and cardiac arrest.
Immediate medical attention is required, as these effects may appear shortly after the overdose. Treatment is symptomatic and must be prompt with immediate evacuation of the stomach by emesis at home, before transportation to the hospital or gastric lavage until the stomach is completely emptied. If finely powdered, activated charcoal is introduced by the stomach tube, after lavage, and within 30 minutes after ingestion of the tablets, it may inhibit further intestinal absorption of the drug.
To be effective, the dose of activated charcoal should be at least five times the estimated dose of hydroxychloroquine ingested. Convulsions, if present, should be controlled before attempting gastric lavage. If due to cerebral stimulation, cautious administration of an ultrashort-acting barbiturate may be tried but, if due to anoxia, it should be corrected by oxygen administration, artificial respiration or, in shock with hypotension, by vasopressor therapy.
Hydroxychloroquine - Side Effects, Dosage, Interactions - Drugs - Everyday Health
Because of the importance of supporting respiration, tracheal intubation or tracheostomy, followed by gastric lavage, may also be necessary. Exchange transfusions have been used to reduce the level of 4-aminoquinoline drug in the blood.
A patient who survives the acute phase and is asymptomatic should be closely observed for at least six hours. Fluids may be forced, and sufficient ammonium chloride 8 g daily in divided doses for adults may be administered for a few days to acidify the urine to help promote urinary excretion in cases of both overdosage and sensitivity.
It is highly effective as a suppressive agent in patients with P. In patients with P. Hydroxychloroquine sulfate tablets are indicated for the treatment of acute attacks and suppression of malaria. In recent years, it has been found that certain strains of P. Treatment with quinine or other specific forms of therapy is therefore advised for patients infected with a resistant strain of parasites. Before starting a long-term treatment, both eyes should be carefully examined for visual acuity, central visual field and color vision. The risk of retinal damages is small with daily doses of up to 6.
Following the administration in doses adequate for the treatment of an acute malarial attack, mild and transient headache, dizziness, and gastrointestinal complaints diarrhea, anorexia, nausea, abdominal cramps and, on rare occasions, vomiting may occur. Cardiomyopathy has been rarely reported with high daily dosages of hydroxychloroquine. Nervous system disorders: Dizziness, headache, and convulsions have been reported with this class of drugs.
You may continue to get better for up to 1 year. Most people who take Plaquenil also take other medicines for pain and stiffness.
What is hydroxychloroquine?
Plaquenil changes the way your immune system works. In some kinds of lupus, your immune system attacks your body instead of protecting it. Plaquenil tries to quiet or slow down the immune system. You take Plaquenil as a pill 1 or 2 times a day. Take the pills with food or milk. Your body weight will tell your doctor what dose is safe for you. If you miss a dose of Plaquenil, do not make it up or double your next dose.
Wait until the next scheduled time, and take your usual dose. After several months your doctor will check your joints for swelling and see how you feel. If you still have pain with your daily activities, then you and your doctor should think about trying another medicine. The most common side effects are diarrhea, nausea, vomiting, headache, dizziness, skin rash or black spots when you look at things. Most side effects will go away when your body gets used to the medicine.
Tell your doctor if you have these side effects. You should not use this medicine if you are allergic to chloroquine or hydroxychloroquine Plaquenil , or if you have: a history of vision changes or damage to your retina caused by an anti-malaria medication. I hope you feel better soon. Keep this information with the tablets. Pharmacology, adverse reactions, warnings and side effects.
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The dose for malaria prevention is mg every week starting 1 or 2 weeks before exposure and for 4 weeks after leaving the high risk area. If you become pregnant while using chloroquine phosphate, call your doctor. He asked me if I thought I'd be OK with a small amount, but I told him that the reason we went to mg bid instead of qd was because I was getting little relief on that quantity.
Hydroxychloroquine mg twice daily or as advised by Rheumatology or Dermatology specialists, once daily. For the treatment of lupus, the suggested dose is mg once or twice daily. After a while, your healthcare provider may recommend a lower dosage such as mg once daily. With Plaquenil, however, the most commonly prescribed anti-malarial, this sort of damage occurs only in 1 out of 5, people who take the drug for five years or more.
This article is from June and may contain outdated material. It has been around for a very long time.