hydroxychloroquine sulfate

Adults: 400 mg (310-mgbase) PO. weekly on same day of week (begin I to 2 weeks before entering endemic area and continue for 4 weeks after leaving endemic area). If not started before exposure, initial dose is doubled to 800 mg (620-mg base) in two divided dosesChildren: 5 mg/kg (base) PO. weekly on same day of week (begin I to 2 weeks before entering endemic area and continue for 4 weeks after leaving endemic area). Don't exceed adult dose. If not started before exposure, initial dose is doubled to 10 mg/kg (base) in two divided doses.

ADVERSE REACTIONS

CNS: irritability, nightmares, ataxia, seizures, psychosis, vertigo, nystagmus, dizziness, hypoactive deep tendon reflexes, lassitudc, skeletal muscle weakness, headache.

CV: T wave inversion or depression, widening of the QRS complex

EENT: blurrcd vision; difficulty in focusing; reversible corneal changes; typically irreversible, sometimes progrcssive or delayed retinal changes such as narrowing of arterioles; macular lesions; pallor of optic disk; optic atrophy; visual field defects; patchy retinal pigmentation, commonly leading to blindness, ototoxicity.

GI: anorexia, abdominal cramps, diarrhea, nausea, vomiting.

Hematologic: agranulocytosis, leukopenia, thrombocytopenia, hemolysis in patients with G6PD deficiency, aplastic anemia.

Skin: pruritus, lichen planus eruptions, skin and mucosal pigmentary changes, pleomorphic skin eruptions, worsened psonasls.

Other: weight loss, alopecia, bleaching of hair.
INTERACTIONS

Drug-drug. Cimetidine: decreased hepatic metabolism of hydroxy chloroquine. Toxicity may occur.

Kaolin, magnesium and aluminum salts: decreased GI absorption. Administration times must be separated
EFFECTS ON DIAGNOSTIC TESTS

None reported
CONTRAINDICATIONS

Contraindicated in patients with retiual or visual field changes, porphyria, or hypersensitivity to drug and in longterm therapy for children
SPECIAL CONSIDERATIONS

Use with extreme caution in patients with severe Gr, neurologic, or blood disorders.

Use cautiously in patients with hepatic disease or alcoholism because drug concentrates in liver, and in those with G6PD deficiency or psoriasis because drug may exacerbate these conditions.

Alert: Drug dosage may be discussed in mg or mg-base; be aware of the difference.

Baseline and periodic ophthalmic examinations should be performed. Tests for ocular muscle weakness should periodically be checked after long-term use.

Patient should undergo audiometric examinations before, during, and aftertherapy, especially if therapy is long-term.

CBC and liver function studies should be monitored periodically during longterm therapy; if severe blood disorder not attributable to disease develops, drug may need to be discontinued.

Alert: Patient should be monitored for possible overdose, which can quickly lead to toxic signs or symptoms: headache, drowsiness, visual disturbances, CV collapse, and seizures, followed by cardiopulmonary arrest. Children are extremely susceptible to toxicity; long-term treatment should be avoided.

Patient teaching

For prophylaxis, take hydroxychloroquine immediately before or after meals on same day each week.

Report adverse reactions promptly.

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