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Chloroquine retinopathy is a form of toxic retinopathy (damage of the retina) caused by the drugs chloroquine or hydroxychloroquine, which are sometimes used in the treatment of autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus. This eye toxicity limits long-term use of the drugs. [3]
Hydroxychloroquine, sold under the brand name Plaquenil among others, is a medication used to prevent and treat malaria in areas where malaria remains sensitive to chloroquine. Other uses include treatment of rheumatoid arthritis, lupus, and porphyria cutanea tarda. It is taken by mouth, often in the form of hydroxychloroquine sulfate. [3]
In particular, quinoline-type drugs are known to be ototoxic. Examples include chloroquine and hydroxychloroquine which are quinine-like. Apart from antimalarial effects, these drugs are also used in the treatment of other diseases such as dermatological, immunological, rheumatological, and severe infectious diseases. [25]
If a drug can bind to unexpected proteins, receptors, or enzymes that can alter different pathways other than those desired for treatment, severe downstream effects can develop. An example of this is the drug eplerenone (aldosterone receptor antagonist), which should increase aldosterone levels, but has shown to produce atrophy of the prostate.
Hydroxychloroquine is more commonly available than chloroquine in the United States. [13] Hydroxychloroquine is used as a prophylactic in India. [24] [25] Hydroxychloroquine and chloroquine have numerous, potentially serious, side effects, such as retinopathy, hypoglycemia, or life-threatening arrhythmia and cardiomyopathy. [26]
Combinations of DMARDs are often used, because each drug in the combination can be used in a smaller dose than if it were given alone, thus reducing the risk of side effects. [citation needed] Many patients receive an NSAID and at least one DMARD, sometimes with low-dose oral glucocorticoids. If disease remission is observed, regular NSAIDs or ...
Common side effects include abdominal pain, vomiting, diarrhea, cough, and itchiness. [3] Serious side effects may include anaphylaxis, Stevens–Johnson syndrome, hallucinations, and liver problems. [3] [4] Side effects are generally mild. [5] It is unclear if use during pregnancy or breastfeeding is safe for the baby. [6]
Alcohol can exacerbate the symptoms and may directly contribute to increased severity of symptoms. The reasons for toxicity vary depending on the mixture of drugs. Usually, most victims die after using two or more drugs in combination that suppress breathing, and the low blood oxygen level causes brain death.