Hydroxychloroquine Sulfate

A to Z Drug Facts

Hydroxychloroquine Sulfate

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(high-drox-ee-KLOR-oh-kwin SULL-fate)

Plaquenil Sulfate

Class: Anti-infective/Antimalarial; Antirheumatic

Action May interfere with parasitic nucleoprotein (DNA/RNA) synthesis and parasite growth or cause lysis of parasite or infected erythrocytes. In rheumatoid arthritis, may suppress formation of antigens responsible for symptom-producing hypersensitivity reactions.

Indications Prophylaxis and treatment of acute attacks of malaria due to Plasmodium vivax, Plasmodium malariae, Plasmodium ovale, and susceptible strains of Plasmodium falciparum. Treatment of chronic discoid and systemic lupus erythematosus (SLE) and acute or chronic rheumatoid arthritis in patients not responding to other therapies.

Contraindications Retinal or visual field changes caused by any 4-aminoquinoline compound; hypersensitivity to 4-aminoquinoline compounds; long-term therapy in children.

Route/Dosage

Suppression of Malaria

ADULTS: PO 400 mg (310 mg of base) weekly on same day each week. CHILDREN: PO 5 mg/kg of base weekly on same day each week, up to maximum of 400 mg (310 mg of base). Begin 1 to 2 weeks prior to exposure; continue for 8 weeks after leaving area.

Acute Attack of Malaria

ADULTS: Initial dose PO 800 mg (620 mg of base). CHILDREN: Initial dose PO 10 mg/kg (base), up to adult dose; give half of initial dose 6 hours later and on days 2 and 3.

Rheumatoid Arthritis

ADULTS: Initially PO 400 to 600 mg/day (310 to 465 mg of base) with food or milk. Maintenance: After good response (usually 4 to 12 weeks), reduce dosage by 50% and continue at PO 200 to 400 mg/day (155 to 310 mg of base). CHILDREN: Although experience with hydroxychloroquine in children for rheumatoid arthritis or lupus erythematosus is limited, its use may be warranted in some cases. A dose of 3 to 5 mg/kg/day, up to a maximum of 400 mg/day (given once or twice daily) has been recommended. Do not exceed a dose of 7 mg/kg/day.

Lupus Erythematosus

ADULTS: Initially PO 400 mg/day or bid. For prolonged therapy, reduce to PO 200 to 400 mg/day (155 to 310 mg of base).

Interactions

Digoxin: May increase serum digoxin levels. Hepatotoxic drugs: May increase potential for hepatotoxicity.

Lab Test Interferences None well documented.

Adverse Reactions

CV: Hypotension; ECG changes. CNS: Headache; irritability; nervousness; emotional changes; nightmares; psychosis; dizziness; vertigo; nystagmus; nerve deafness; convulsions; ataxia. DERM: Bleaching of hair; alopecia; pruritus; skin and mucosal pigmentation; skin eruptions; exacerbation of psoriasis. EENT: Disturbance of accommodation with blurred vision; transient corneal edema; corneal opacities; decreased corneal sensitivity; retinal edema; retinal atrophy; abnormal retinal pigmentation; loss of retinal reflexes; optic disc pallor and atrophy; scotoma; retinopathy; tinnitus. GI: Anorexia; nausea; vomiting; diarrhea; abdominal cramps. HEMA: Aplastic anemia; agranulocytosis; leukopenia; thrombocytopenia; hemolysis in G-6-PD deficiency; exacerbation of porphyria. META: Weight loss. OTHER: Immunoblastic lymphadenopathy; extraocular muscle palsies; skeletal muscle weakness; absent or hypoactive deep tendon reflexes.

Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Deaths have occurred following accidental ingestion of relatively small doses. Do not exceed recommended doses for children with malaria. Not indicated for juvenile rheumatoid arthritis. Special risk patients: May exacerbate psoriasis, porphyria, or other dermatitis; may cause hemolysis in patients with G-6-PD deficiency. Renal/Hepatic disease or alcoholism: May increase risk of hepatotoxicity in these conditions. Muscular weakness: If weakness occurs, discontinue. Ophthalmic effects: Irreversible retinal damage with long-term hydroxychloroquine therapy has been observed.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Give medication with food or milk.
Store at room temperature in tightly closed container and protect from light.

Assessment/Interventions

Obtain complete patient history, including drug history and any known allergies.
Monitor periodic blood counts, and include eye examinations and knee and ankle reflex testing in assessments of patients on prolonged therapy.
Monitor liver function throughout therapy.
If unusual bleeding or bruising occurs, notify health care provider and withhold IM injections.

OVERDOSAGE: SIGNS & SYMPTOMS
	Headache, drowsiness, visual disturbances, cardiovascular collapse, convulsions, respiratory and cardiac arrest, bradycardia, ventricular fibrillation

Patient/Family Education

Advise patient to take with food or milk and to discontinue drug and notify health care provider if severe stomach pain, loss of appetite, nausea, vomiting, or diarrhea occurs.
Explain that urine may be brown or rust color.
If drug is being taken to prevent malaria, instruct patient to take each dose on same day each week.
Advise patient to avoid alcohol during therapy.
Instruct patient to have periodic eye examinations during long-term therapy.
If drug is being taken for rheumatoid arthritis, explain to patient that it may take up to 6 months for drug to take effect and to notify health care provider if condition has not improved at this time.
Advise patient to discontinue drug and notify health care provider if any of following occurs: Fever, sore throat, unusual bleeding or bruising; changes in vision; ringing in ears or hearing loss; changes in color of skin or oral surfaces; skin rash or itching; muscle weakness; bleaching or loss of hair; mood or mental changes.
If diarrhea, loss of appetite, nausea, vomiting, abdominal pain becomes persistent or bothersome, advise patient to notify health care provider.