Pharm

Hydroxychloroquine

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Hydroxychloroquine, Plaquenil

  • 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
  • Dose
  1. Initial: 200 mg PO bid
  2. Taper after 1-2 years when stable: 200 mg PO qd
  • Adverse Effects
  1. 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
  3. Gastrointestinal adverse effects
    1. Increased stool frequency
    2. Diarrhea
    3. Bloating
    4. Nausea
  4. Cardiovascular adverse effects
    1. Palpitations
    2. Premature Atrial Contractions
    3. Conduction defects
  • Monitoring
  1. Routine Eye Exam every 6-12 months