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. 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.
Drug spotlight on hydroxychloroquine
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. 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. It enhances hypoglycemic effects of insulin and oral hypoglycemic agents. Dose altering is recommended to prevent profound hypoglycemia. Antacids may decrease the absorption of HCQ. Both neostigmine and pyridostigmine antagonize the action of hydroxychloroquine. While there may be a link between hydroxychloroquine and hemolytic anemia in those with glucosephosphate dehydrogenase deficiency , this risk may be low in those of African descent.
Specifically, the FDA drug label for hydroxychloroquine lists the following drug interactions  :. Hydroxychloroquine has similar pharmacokinetics to chloroquine , with rapid gastrointestinal absorption and elimination by the kidneys. Antimalarials are lipophilic weak bases and easily pass plasma membranes. The free base form accumulates in lysosomes acidic cytoplasmic vesicles and is then protonated ,  resulting in concentrations within lysosomes up to times higher than in culture media.
Keeping an eye out for problems
This increases the pH of the lysosome from 4 to 6. Hydroxychloroquine increases  lysosomal pH in antigen-presenting cells. In inflammatory conditions, it blocks toll-like receptors on plasmacytoid dendritic cells PDCs. Toll-like receptor 9 TLR 9 recognizes DNA-containing immune complexes and leads to the production of interferon and causes the dendritic cells to mature and present antigen to T cells , therefore reducing anti-DNA auto-inflammatory process. In , a novel mechanism was described wherein hydroxychloroquine inhibits stimulation of the toll-like receptor TLR 9 family receptors.
TLRs are cellular receptors for microbial products that induce inflammatory responses through activation of the innate immune system. As with other quinoline antimalarial drugs, the mechanism of action of quinine has not been fully resolved. The most accepted model is based on hydrochloroquinine and involves the inhibition of hemozoin biocrystallization , which facilitates the aggregation of cytotoxic heme. Free cytotoxic heme accumulates in the parasites, causing their deaths.
Drug spotlight on hydroxychloroquine
It is frequently sold as a sulfate salt known as hydroxychloroquine sulfate. On 13 February , hydroxychloroquine and chloroquine were recommended by a South Korean task force for the experimental treatment of coronavirus disease COVID A randomized controlled trial by Chinese researchers showed no positive effect with hydroxychloroquine at a dosage of mg per day. From Wikipedia, the free encyclopedia. Antimalarial medication.
Psychomotor Agitation Following Treatment with Hydroxychloroquine
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Interactive image. Main article: Chloroquine retinopathy. Retrieved 21 March Archived from the original on 20 March The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.
Hydroxychloroquine has been detected in human breast milk. Because of the possibility for adverse reactions in nursing infants from hydroxychloroquine, a choice should be made whether to stop nursing or to stop use of this medication. The importance of the drug to the mother should be considered. It is known that infants are extremely sensitive to the toxic effects of this medication. It is taken once or twice a day, unless it is used for the prevention of malaria , in which case it is taken once a week beginning 1 to 2 weeks prior to traveling to an area where malaria is common.
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If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of hydroxychloroquine at the same time. Take this medication exactly as prescribed by your doctor.
Follow the directions on your prescription label carefully. The recommended maintenance dose range of hydroxychloroquine Plaquenil for the treatment of rheumatoid arthritis is to mg daily. The recommended maintenance dose range of hydroxychloroquine Plaquenil for the treatment of lupus erythematosus is to mg daily.
If you take too much hydroxychloroquine, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away. Hydroxychloroquine prevents and treats certain types of malaria infections. It is also used to treat lupus and rheumatoid arthritis. How was your experience with Hydroxychloroquine? First, a little about yourself Male Female. What tips would you provide a friend before taking Hydroxychloroquine?
Choose one. Back Next. How well did Hydroxychloroquine work for you? Did you experience many side effects while taking this drug? How likely would you be to recommend Hydroxychloroquine to a friend?
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