Pharm

Hydroxychloroquine

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Hydroxychloroquine, Plaquenil

  • Indications
  1. Early Rheumatoid Arthritis
    1. Especially Antinuclear Antibody positive
  2. Systemic Lupus Erythematosus
  3. Malaria Prophylaxis and treatment
    1. Regions without Chloroquine resistance, non-severe infections
  4. Rheumatologic off-label uses
    1. Dermatomyositis
    2. Sjogren Syndrome
    3. Sarcoidosis
  5. Infectious off-label uses
    1. Q Fever
  6. NOT indicated in COVID-19 outside of clinical trials
    1. Initial studies as of May 2020 suggest no benefit and adverse effect risk (including QTc Prolongation)
  • Mechanism
  1. Antimalarial agent used in rheumatic disease
  2. Modified Chloroquine to reduce Retinopathy risk
  • Efficacy
  1. Response in 70-80% of cases
  2. Response occurs in 3-6 months
  3. Highest efficacy when used early in disease process
  1. Varies significantly based on use
    1. Lower doses are used in infectious disease
  2. Initial: 200 mg orally twice daily
  3. Taper after 1-2 years when stable: 200 mg PO qd
  • Adverse Effects
  1. Eye-related Adverse Effects
    1. Epithelial Keratopathy and other Corneal disorders
    2. Retinopathy
      1. Rare (contrast with Chloroquine)
  2. Neurologic adverse effects
    1. Early toxicity (subsides within 2 weeks)
      1. Irritability
      2. Insomnia
      3. Headache
    2. Late toxicity requires medication discontinuation
      1. Tinnitus
      2. Decreased Hearing acuity
    3. Very rare toxicity
      1. Myopathy or muscular weakness
    4. Other adverse effects
      1. Confusion or Delirium
      2. Extrapyramidal Side Effects
      3. Hallucinations
  3. Gastrointestinal adverse effects
    1. Increased stool frequency
    2. Diarrhea
    3. Bloating
    4. Nausea
  4. Endocrine Adverse Effects
    1. Hypoglycemia
  5. Hematologic Adverse Effects
    1. Neutropenia
    2. Pancytopenia
  6. Cardiovascular adverse effects
    1. Palpitations
    2. Premature Atrial Contractions
    3. QTc Prolongation (with risk of Ventricular Tachycardia or Drug-Induced Torsades de Pointes)
      1. Increased risk when combined with other agents causing QTc Prolongation (e.g. Azithromycin)
  • Monitoring
  1. Routine Eye Exam every 6-12 months