Uncommon Alopecia ; corneal oedema ; dizziness ; eye disorders ; hair colour changes ; nervousness ; neuromuscular dysfunction ; retinopathy ; seizure ; tinnitus ; vertigo. Frequency not known Acute hepatic failure ; agranulocytosis ; anaemia ; angioedema ; bone marrow disorders ; bronchospasm ; cardiac conduction disorders ; cardiomyopathy ; hearing loss ; hypoglycaemia ; leucopenia ; movement disorders ; muscle weakness ; myopathy ; photosensitivity reaction ; psychosis ; reflexes absent ; severe cutaneous adverse reactions SCARs ; thrombocytopenia ; tremor ; ventricular hypertrophy.
Teva and Mylan to jumpstart production of old malaria drug to fight the novel coronavirus
Overdose Hydroxychloroquine is very toxic in overdosage; overdosage is extremely hazardous and difficult to treat. Avoid—risk of toxicity in infant. Manufacturer advises caution. Manufacturer advises consider dose adjustment in severe impairment. Monitor plasma-hydroxychloroquine concentration in severe renal impairment. Monitoring of patient parameters Manufacturers recommend regular ophthalmological examination but the evidence of practical value is unsatisfactory see advice of the Royal College of Ophthalmologists.
Back to top. After 6 months his right hand grip improved and the left hand became almost normal. When the patient's condition had stabilized, chloroquine was discontinued. In this patient chloroquine was effective despite the poor response to corticosteroids. In , a year-old man, otherwise asymptomatic, was found to have bilateral hilar adenopathy on a chest radiograph obtained during the workup for chronic sinusitis.
Tuberculin, histoplasmin, and coccidioidin skin tests were negative. In , the patient became dyspneic.
A chest radiograph at that time showed bilateral pulmonary infiltrates. A lymph node biopsy specimen showed noncaseating granulomas.
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Bronchial lavage failed to grow acid-fast bacilli or fungi. Because of his symptoms, that patient was given prednisone, which he took for 6 months. In January , while not taking prednisone, he developed numbness of the right hand and tingling of both hands and forearms.
All upper-extremity muscle groups were mildly weak, with a score of 3 to 4 on a scale of 0 to 5. There was no muscle atrophy or fasciculation. An unenhanced MR image of the brain and spinal cord was normal in February An electromyogram and a nerve conduction study of the right upper extremity were normal except for mild slowing for motor median conduction across the wrist. The significance of the minimal stalling for median conduction was unclear.
There was no evidence of radiculopathy. Treatment was restarted with prednisone, 60 mg daily. Within 6 months, there was a complete resolution of numbness, tingling, and muscle weakness. The patient, however, had become severely depressed and cushingoid. The prednisone dosage was gradually reduced. He remained obese and depressed. A few months later his right Achilles tendon ruptured. At this point, hydroxychloroquine sulfate, mg twice a day, was added. His muscle weakness and numbness abated. Hydroxychloroquine was continued for 18 months.
When last seen in , the patient had no neurological symptoms. He had lost weight and was no longer depressed. A chest radiograph and serum ACE level were normal.
Industry ups chloroquine production, donates millions of doses
A year-old African American man with a history of pulmonary, cutaneous, and upper respiratory tract sarcoidosis, diagnosed in , developed marked fatigue, headaches, and eye pain. Examination of his eyes disclosed mild low-grade vitreitis. Serum ACE level was normal. An MR image of the brain showed diffuse leptomeningeal enhancement in the frontal lobes, interhemispheric fissure, and right temporal and occipital lobes Figure 2 , left, and Figure 3 , left.
The patient stopped using prednisone because of depression but continued taking hydroxychloroquine. After 8 months his headaches and weakness improved markedly. A repeated MR image after 11 months showed moderate improvement Figure 2 , right. Because of the residual MR imaging abnormality, the patient was given hydroxychloroquine for another 5 months. When the drug was discontinued after 1 year, the patient's symptoms recurred. The MR imaging was not repeated, but hydroxychloroquine sulfate, mg twice a day, was reinstituted with improvement in symptoms. Left, Gadolinum-enhanced magnetic resonance image axial view of the brain showing multiple areas of diffuse leptomeningeal enhancement in the temporal and occipital lobes.
There is no evidence of optic nerve involvement patient 9; Table 1. Right, Much diminished leptomeningeal enhancement after treatment with hydroxychloroquine sulfate, mg, twice a day for 5 months. Left, Gadolinium-enhanced magnetic resonance image of the brain coronal view showing extensive leptomeningeal enhancement patient 9; Table 1.
Right, Five months after hydroxychloroquine sulfate treatment, leptomeningeal enhancement is much diminished. In March , a year-old African American man was examined because of increasing fatigue, polydipsia, nocturia, and decreased libido. A mediastinal lymph node biopsy showed noncaseating granuloma. A computed tomographic scan of the brain showed a 1-cm suprasellar enhancing mass.
Serum ACE level was In August , computed tomography showed reduction in size of the pituitary mass. The patient did not tolerate prednisone; his weight and serum cholesterol level increased. Headaches reappeared and he developed uveitis.
Optic atrophy secondary to a chiasmal mass appeared. This was most likely related to his poor compliance with treatment. In , an exploration of the optic chiasma was performed. The arachnoid at the base of the skull was peppered with sarcoid granulomas. The optic chiasma was diffusely thickened and enlarged. The lesion was not surgically resectable.
His neurological status deteriorated. Because of the compliance problems and corticosteroid-induced side effects, the patient was given hydroxychloroquine sulfate, mg twice a day. The patient's condition stabilized initially, but the disease slowly progressed despite hydroxychloroquine therapy for 2 years. Regular neurological and eye examinations disclosed no evidence of hydroxychloroquine toxic effects. Chloroquine phosphate, a 4-aminoquinoline, is used extensively in treating acute malaria.
The anti-inflammatory effects of chloroquine are well known. This drug has been used to treat rheumatoid arthritis, amebiasis, discoid lupus erythematosus, porphyria cutanea tarda, and solar urticaria. In recommended doses the drug is safe; however, in high doses it can cause irreversible ototoxic effects and retinopathy. The latter is related to drug accumulation in melanin-rich tissues. For patients receiving long-term high-dose therapy, ophthalmological and neurological evaluation is recommended every 3 to 6 months.
Ocular toxic effects are not seen with this regimen. Its therapeutic action against falciparum malaria is similar to that of chloroquine. It is preferred for treatment of rheumatoid arthritis, lupus erythematosus, and sarcoidosis because the ocular toxic effects are minimal. Ocular supervision is needed, although the drug has not been reported to cause retinal damage. The use of chloroquine or hydroxychloroquine specifically for neurosarcoidosis has not been described. In this small open trial with the use of these drugs in neurosarcoidosis, the following patterns emerged Table 1.
The patients with neurosarcoidosis who failed to respond to corticosteroids did case 5 or did not cases 1 and 11 respond to chloroquine. In patients who responded favorably to corticosteroids but did not want to continue because of severe corticosteroid-related side effects, chloroquine or hydroxychloroquine was beneficial in controlling the disease cases 2 and 4. For patients who could only tolerate smaller doses of prednisone because of side effects but whose disease required higher doses, adding chloroquine or hydroxychloroquine was desirable because of its corticosteroid-sparing effect case 6.
In patients who did not wish to take corticosteroids, chloroquine or hydroxychloroquine could be given.
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In one such patient case 9 , there was clear evidence of improvement as evidenced on MR images. The second patient case 10 showed only subjective improvement. This was not a prospective, controlled, double-blind study.