Falciparum Discontinue in 6 months if improvement is inadequate Use in patients with psoriasis may precipitate a severe attack of psoriasis; use with caution Postmarketing cases of life-threatening and fatal cardiomyopathy reported with use of hydroxychloroquine as well as of chloroquine Irreversible retinal damage observed in some patients who had received hydroxychloroquine sulfate; significant risk factors for retinal damage include daily doses of hydroxychloroquine sulfate greater than 6.5 mg/kg (5 mg/kg base) of actual body weight, durations of use greater than five years, subnormal glomerular filtration, use of some concomitant drug products such as tamoxifen citrate and concurrent macular disease Ocular examination is recommended within first year of therapy; baseline exam should include: best corrected distance visual acuity (BCVA), an automated threshold visual field (VF) of the central 10 degrees (with retesting if an abnormality is noted), and spectral domain ocular coherence tomography (SD-OCT) For individuals with significant risk factors (daily dose of hydroxychloroquine sulfate 5.0 mg/kg base of actual body weight, subnormal glomerular filtration, use of tamoxifen citrate or concurrent macular disease) monitoring should include annual examinations which include BCVA, VF and SD-OCT; for individuals without significant risk factors, annual exams can usually be deferred until five years of treatment In individuals of Asian descent, retinal toxicity may first be noticed outside macula; in patients of Asian descent, it is recommended that visual field testing be performed in central 24 degrees instead of central 10 degrees Hydroxychloroquine should be discontinued if ocular toxicity is suspected and patient should be closely observed given that retinal changes (and visual disturbances) may progress even after cessation of therapy Hepatic disease or alcoholism Glucose-6-phosphate dehydrogenase (G6PD) deficiency is associated with hemolysis and renal impairment; use with caution Dermatologic reactions to hydroxychloroquine may occur Patients are prone to dermatitis outbreaks Signs or symptoms of cardiac compromise have appeared during acute and chronic treatment; clinical monitoring for signs and symptoms of cardiomyopathy is advised, including use of appropriate diagnostic tools such as ECG to monitor patients for cardiomyopathy during therapy; if cardiotoxicity is suspected, prompt discontinuation may prevent life-threatening complications Not for administration with other drugs that have potential to prolong QT interval; hydroxychloroquine prolongs QT interval; ventricular arrhythmias and torsades de pointes reported in patients taking hydroxychloroquine Skeletal muscle myopathy or neuropathy leading to progressive weakness and atrophy of proximal muscle groups, depressed tendon reflexes, and abnormal nerve conduction, reported; muscle and nerve biopsies have been associated with curvilinear bodies and muscle fiber atrophy with vacuolar changes; assess muscle strength and deep tendon reflexes periodically in patients on long-term therapy Suicidal behavior rarely reported in patients treated with hydroxychloroquine Hematologic reactions (including aplastic anemia) and agranulocytosis may occur May exacerbate heart failure Shown to cause severe hypoglycemia including loss of consciousness that could be life threatening in patients treated with or without antidiabetic medications; warn patients about risk of hypoglycemia and associated clinical signs and symptoms; patients presenting with clinical symptoms suggestive of hypoglycemia during treatment should have their blood glucose checked and treatment reviewed as necessary A reduction in dosage may be necessary in patients with hepatic or renal disease, as well as in those taking medicines known to affect these organs Use with caution in patients with hepatic disease or alcoholism or in conjunction with known hepatotoxic drugs Consider discontinuing therapy if any severe blood disorder such as aplastic anemia, agranulocytosis, leukopenia, or thrombocytopenia, which is not attributable to the disease under treatment appears; perform periodic blood cell counts if patients are given prolonged therapy Pregnancy category: C Lactation: Drug is concentrated in breast milk (American Academy of Pediatrics committee states that it is compatible with nursing) A: Generally acceptable. Contact the applicable plan provider for the most current information. Controlled studies in pregnant women show no evidence of fetal risk. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. Animal studies show risk and human studies not available or neither animal nor human studies done. Plaquenil autoimmune thyroiditis Plaquenil eye Hydroxychloroquine is a front-line treatment for systemic lupus erythematosus and other rheumatic diseases, but can cause retinopathy. Improved detection techniques for the early stages pre. Mechanism of Action of Hydroxychloroquine as an Antirheumatic Drug By Robert I. Fox The antimalarial agents chloroquine and hydroxychloroquine have been used widely for the treatment of rheumatoid arthritis and systemic lupus erythematosus. Mechanism of action of hydroxychloroquine as an antirheumatic drug. Fox RI1. Author information 1Department of Rheumatology, Scripps Clinic and Research Foundation, La Jolla, CA 92037. The antimalarial agents chloroquine and hydroxychloroquine have been used widely for the treatment of rheumatoid arthritis and systemic lupus erythematosus. Unknown; may impair complement-dependent antigen-antibody reactions; inhibits locomotion of neutrophils and chemotaxis of eosinophils Increases p H and interferes with lysosomal degradation of hemoglobin, which in turn interferes with digestive vacuole function Bioavailability: Rapid and complete absorption Onset: May take 4-6 months to show response; peak response takes several months (rheumatic disease) Duration: Unknown Peak plasma time: 1-3 hr Protein bound: 55% Metabolites: Desethylhydroxychloroquine, desethylchloroquine Half-life: 32-50 days Excretion: Urine (60%) The above information is provided for general informational and educational purposes only. D: Use in LIFE-THREATENING emergencies when no safer drug available. Hydroxychloroquine mechanism of action lupus Hydroxychloroquine A multifaceted treatment in lupus., Mechanism of action of hydroxychloroquine as an. Plaquenil skin rash picturesWhat should you test for with hydroxychloroquineAnti malarial tablets chloroquineHydroxychloroquine toxicity monitoringPlaquenil assistance program Objectives. This review examines the pharmacokinetics, modes of action and therapeutic properties of the anti-malarial drugs, hydroxychloroquine HCQ and chloroquine CQ, in the treatment of systemic lupus erythematosus SLE, rheumatoid arthritis RA and related conditions, as well as osteoarthritis OA. Therapy and pharmacological properties of hydroxychloroquine.. Mechanism of action of hydroxychloroquine as an antirheumatic.. Hydroxychloroquine decreases Th17-related cytokines in.. Hydroxychloroquine Sulfate Drug Information from Includes Hydroxychloroquine Sulfate side effects, interactions and indications. lupus erythematosus suppressant—. Recent developments in the understanding of the pharmacokinetics and mechanism of action of chloroquine. Ther Drug Monit 1989; 114 369-79. Medscape - Indication-specific dosing for Plaquenil hydroxychloroquine sulfate, frequency-based adverse effects, comprehensive interactions, contraindications, pregnancy & lactation schedules, and cost information. The mechanisms of action of HCQ, and clinical and experimental data in systemic lupus erythematosus SLE and APS are discussed. As HCQ reduces the risk of thrombosis in both SLE patients and animal models of APS 1–7, and possibly decreases the titre of aPL 8, its beneficial role as a potential antithrombotic could be suggested.