- Hydroxychloroquine | DermNet NZ.
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- Hydroxychloroquine - Wikipedia.
This causes:. These lysosomotropic effects occur in macrophages , dendritic cells , and lymphocytes. Hydroxychloroquine has a two-fold impact on T cells.
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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. 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.
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.
Who uses hydroxychloroquine?
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. Drug information provided by: IBM Micromedex. Take this medicine only as directed by your doctor.
Hydroxychloroquine (Plaquenil®) Drug Information Sheet
Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Swallow the tablet whole. Do not crush, break, or chew it. Take this medicine with meals or milk to lessen stomach upset, unless otherwise directed by your doctor. Keep using this medicine for the full treatment time, even if you feel better after the first few doses. Your infection may not clear up if you stop using the medicine too soon.
If you are also taking kaolin or antacids, take them at least 4 hours before or after using hydroxychloroquine.
HYDROXYCHLOROQUINE SULFATE | Drug | BNFc content published by NICE
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine.
If your dose is different, do not change it unless your doctor tells you to do so. The weekly dosage for adults is mg base mg salt. Antimalarial drugs are available in the United States by prescription only. Medicines should be obtained at a pharmacy before travel rather than in the destination country.
Buying medications abroad has its risks: the drugs could be of poor quality, contaminated, or counterfeit and not protect you against malaria. In what parts of the world can hydroxychloroquine be used for prevention of malaria in travelers?
Hydroxychloroquine can only be used in places where chloroquine a related medicine is still effective. There are only a few places left in the world where hydroxychloroquine is still effective including parts of Central America and the Caribbean.
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