Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Hydroxychloroquine”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources
PubMed1993

Hydroxychloroquine and chloroquine: assessing the risk of retinal toxicity.

BACKGROUND: During the past 10 years there has been an increase in the use of the antimalarial agents, chloroquine and hydroxychloroquine, in the treatment of various rheumatic diseases. METHODS: In the United States, hydroxychloroquine (Plaquenil) is one of the most commonly prescribed medications for mild to moderately severe rheumatoid arthritis. Both chloroquine and hydroxychloroquine have the potential to produce an irreversible maculopathy. However, this maculopathy occurs almost exclusively at higher than recommended doses. RESULTS: Careful dose monitoring by the rheumatologist, combined with appropriate ocular examination by the eye care professional, can significantly reduce the risk of retinopathy. CONCLUSIONS: This paper discusses the use of chloroquine and hydroxychloroquine in the treatment of rheumatoid arthritis and systemic lupus erythematosus, it summarizes their retinotoxic risk, and it outlines the diagnostic techniques used to evaluate patients treated with these medications.

Arthritis, Rheumatoid↗
PubMed1995

[Hydroxychloroquine-puvatherapy photoinduced acute generalized exanthematous pustulosis].

INTRODUCTION: Acute generalized exanthematous pustulosis usually occurs as a typical skin reaction to drugs. We observed a case with a photodistribution induced by hydroxychloroquine and/or PUVA. CASE REPORT: A male subject had been treated for actinic pseudolymphoma since 1988. General corticosteroids had been given initially and were followed by PUVA and azathioprine. A new episode with erythema involving the trunk and the proximal portion of the limbs was treated with corticosteroids and hydroxychloroquine. The symptomatology regressed but pustular erythema developed in exposed areas two days after a PUVA session on the upper part of the body. The eruption did not involve the zones of the phototests one month earlier. The lesions resolved rapidly after withdrawal of hydroxychloroquine and PUVA. DISCUSSION: Photo-induced acute generalized exanthematous pustulosis with a photodistribution has not been reported previously. The imputability of hydroxychloroquine and PUVA, and their association is suggested. The appearance of pustular lesion on exposed areas and the protection resulting from the phototests would lead to several hypotheses. General corticosteroids were ineffective in preventing and in treating acute generalized exanthematous pustulosis.

Acute Disease↗
PubMed1996

Treatment of primary Sjögren's syndrome with hydroxychloroquine: a retrospective, open-label study.

OBJECTIVES: To determine whether patients with primary Sjögren's syndrome (SS), diagnosed according to San Diego criteria, had improvement in their laboratory or clinical features during treatment with hydroxychloroquine (6-7 mg/kg/day) for at least two years. METHODS: The study population included 50 consecutive patients with primary SS who were diagnosed according to San Diego criteria, and in whom hydroxychloroquine was suggested as treatment. This group included 10 patients who were early dropouts (side effects or desire not to take antimalarial drugs) and 40 patients who received drugs for at least two years (range 24-48 months). In a subset of SS patients, values for ESR (westergren) and quantitative immunoglobulins were available for comparison. Improvement with therapy was defined as: (a) > or = 20% improvement in variables of tear flow (Schirmer's test I) or corneal integrity (rose Bengal): (b) > or = 20% salivary function (flow rate); and (c) improvement in at least two of the following measures: physicians assessment of global disease activity by > or = 20%, patient assessment of improvement in pain or fatigue by > or = 20%, and ESR improved by > or = 20 mm/hr. RESULTS: In a retrospective study of SS patients who completed the trial, a significant improvement was noted in ocular symptoms (pain and dryness) in patients (55 and 57%) and improved corneal integrity (rose Bengal straining) in 53% of patients. The Schirmer's test was improved by > or = 2 mm/5 minutes in 50% in patients. Improvement was noted in oral symptoms (pain and dryness) in patients (57 and 60%) and salivary flow rate was increased in 82% of patients. In a subset of SS patients evaluated, the ESR improved by > or = 20 mm/hr in 17/32 patients (53%) and quantitative IgG level by > or = 20% in 8/13 patients (61%). Physician global assessment of overall patient status and patient assessment of overall status indicated improvement in over 62% of patients. CONCLUSION: In a retrospective study of patients fulfilling San Diego Criteria for SS, we found: (a) sustained improvement of local symptoms (painful eyes, painful mouth) and improvement of systemic manifestations (arthralgias and myalgias) after treatment with hydroxychloroquine 6-7 mg/kg/day over mean three-year follow-up; (b) laboratory analysis showed a significant improvement in their ESR and their quantitative IgG levels; (c) no significant late toxicity was observed in this study cohort. A prospective study of hydroxychloroquine in patients fulfilling San Diego criteria for SS is indicated.

Adolescent↗
PubMed1996

Hydroxychloroquine in pregnant patients with systemic lupus erythematosus.

OBJECTIVE: To determine the safety for both mother and fetus of antimalarial drugs, i.e., chloroquine and hydroxychloroquine, in pregnant patients with lupus who continued antimalarial drugs throughout pregnancy. Stopping antimalarial drugs can precipitate disease flares of systemic lupus erythematosus (SLE), which are known to be detrimental to the outcome of pregnancy in patients with SLE. Stopping antimalarial drugs during pregnancy therefore not only puts the mother's health at risk but can also compromise the outcome of pregnancy. METHODS: We document 9 pregnancies in 8 patients with lupus, all of whom took hydroxychloroquine (Plaquenil) throughout pregnancy. All 9 pregnancies, which occurred since our first report in 1988, resulted in 9 live births (4 full term and 5 preterm). RESULTS: No congenital abnormalities occurred and mean followup of 33 months (range 10-72 months) revealed no abnormalities in these children. Temporary discontinuation of hydroxychloroquine for 1 month precipitated a flare of disease in one mother, documented both clinically and serologically. CONCLUSION: It is safer to continue hydroxychloroquine rather than to discontinue this drug simply because of pregnancy.

Antimalarials↗
PubMed1999

Hypoglycemia induced by hydroxychloroquine in a type II diabetic treated for polyarthritis.

A 77-year-old man with type II diabetes taking a stable dose of subcutaneous, twice daily human insulin developed symmetrical, inflammatory, rheumatoid factor positive polyarthritis. Within 2 weeks of starting therapy with prednisone 5 mg daily and hydroxychloroquine 400 mg daily he had 2 episodes of severe hypoglycemic coma requiring emergency care. His blood glucose became controlled again when his insulin was decreased by 37%. There are no reported cases of hypoglycemia in diabetic or nondiabetic patients treated with hydroxychloroquine. Hydroxychloroquine has been reported to reduce insulin requirements in refractory type II diabetes by an average of 30%. When hydroxychloroquine is initiated for the treatment of polyarthritis in a type II diabetic requiring insulin or sulfonylurea treatment, blood glucose levels should be monitored closely and the insulin dose may need to be reduced.

Aged↗
PubMed1999

Treatment of Q fever endocarditis: comparison of 2 regimens containing doxycycline and ofloxacin or hydroxychloroquine.

BACKGROUND: Q fever endocarditis, caused by Coxiella burnetii, is fatal in 25% to 60% of patients. Currently, treatment with a long-term tetracycline and quinolone regimen for at least 4 years is recommended, although relapses are frequent. METHODS: Between January 1987 and December 1997, the reference treatment of Q fever endocarditis was compared with one of doxycycline and hydroxychloroquine sulfate. Patients were treated by conventional therapy until May 1991 and then by the new regimen. Microimmunofluorescence was used for antibody-level determination for diagnosis and follow-up. RESULTS: Thirty-five patients were included in the study, 26 males and 9 females. Of 14 patients treated with a doxycycline and quinolone combination, 1 died, 7 relapsed (3 were re-treated and 4 switched to the new regimen), 1 is still being treated, and 5 were considered cured using this regimen only. The mean duration of therapy for cure in this group was 55 months (median, 60 months). Twenty-one patients received the doxycycline and hydroxychloroquine regimen: 1 patient died of a surgical complication, 2 are still being treated, 17 were cured, and 1 is currently being evaluated. Two patients treated for 12 months but none of the patients treated for longer than 18 months relapsed. The mean duration of treatment in this group was 31 months (median, 26 months). No significant differences were observed between the 2 regimens in terms of death, valve surgery, or tolerance. The mortality rate for both regimens in this study was 5%. CONCLUSION: Prescription of the doxycycline and hydroxychloroquine combination for at least 18 months allows shortening of the duration of therapy and reduction in the number of relapses.

Adult↗
PubMed2007

Secondary myelodysplastic syndrome after hydroxychloroquine therapy.

Primary myelodysplastic syndromes (MDS) occur in the absence of exposure to ionizing radiation, chemotherapeutic agents or myelotoxic drugs, whereas secondary MDS occurs in the presence of such exposure. We encountered 4 patients among 217 patients on hydroxychloroquine for rheumatological conditions in 2005 diagnosed with MDS. Two patients were male and two were female; the median age was 69.75 years, (range 65-76). The dose of hydroxychloroquine for all patients was 400 mg daily with median treatment duration of 10.5 years and a range of 6-16. All patients had bone marrow biopsy confirmation of the diagnosis of MDS. The incidence of MDS in a group older than 70 years ranges from 15 to 50/100,000 persons per year. The diagnosis of 4 cases of MDS among 217 patients in 1 year is approximately 123-137-fold higher than the risk of MDS in the general population aged more than 70 years (P < 0.001) and suggests that long-term treatment with hydroxychloroquine is associated with an increased risk of developing secondary MDS.

Aged↗
PubMed2004

The effects of colchicine and hydroxychloroquine on the cyclo-oxygenases COX-1 and COX-2.

OBJECTIVE: The aim of this study was to test whether colchicine and hydroxychloroquine have an inhibitory effect on cyclo-oxygenases (COX). METHODS: Measurement of COX-1 and COX-2 activity was performed by using whole blood assay. Serum thromboxane (TXA) and plasma prostaglandin 2 (PGE2) levels were determined using a commercially available enzyme immunoassay kit. Celecoxib, etodolac, and nimesulide were also tested as controls. Since the study was intended to find a qualitative effect rather than a quantitative relationship between the drugs and the enzymes, we used higher concentrations than the therapeutic range. RESULTS: Colchicine did not have an inhibitory effect on cyclo-oxygenases. Hydroxychloroquine had a mild inhibitory effect in a relatively high concentration. As expected, celecoxib, etodolac, and nimesulide did have an inhibitory effect on the cyclo-oxygenases. CONCLUSIONS: Neither colchicine nor hydroxychloroquine exert their anti-inhibitory effect through inhibition of cyclo-oxygenases.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1983

Ophthalmologic safety of long-term hydroxychloroquine sulfate treatment.

The fear of retinal toxicity has been a major factor limiting the use of chloroquine and hydroxychloroquine. Patients reported to develop retinal toxicity with visual loss usually took daily dosages higher than those currently in use. Toxicity with low dosages (for example, 250 mg per day chloroquine or 400 mg per day hydroxychloroquine) usually reveals pigment abnormalities; associated loss of vision is rare. When 99 patients treated with hydroxychloroquine for more than one year were studied prospectively, four patients showed evidence of retinal toxicity; none developed visual loss, and all abnormalities were completely reversible after drug discontinuation. All persons receiving antimalarials should be evaluated by an ophthalmologist at baseline and every six months thereafter. Funduscopic examinations and visual field testing with a red object must be included. Although this protocol may detect abnormalities that are not drug related, no loss of vision has developed in patients so monitored.

Adult↗
PubMed1983

Hydroxychloroquine sulfate in rheumatoid arthritis: long-term response rate and predictive parameters.

Review of the records of 108 patients with rheumatoid arthritis who were treated with hydroxychloroquine sulfate for at least six months revealed that 63 percent responded: 12 percent achieved complete remission (no joint pain or tenderness, two or less joints with trace swelling); 14 percent showed a 75 percent response (75 percent or greater reduction in active joint count and 50 percent or greater reduction in morning stiffness); and 37 percent had between 30 percent (30 percent or greater reduction in active joint count and morning stiffness) and 75 percent response. Once response was obtained, flare-up of rheumatoid arthritis was uncommon. Only two of 108 patients developed retinopathy (subclinical); it resolved with drug discontinuation and did not cause visual deficits. Better grip strength and radiographs showing little articular damage at baseline might predict response to treatment with hydroxychloroquine. However, even though early disease may be more responsive, long-term rheumatoid arthritis does not preclude a good response to hydroxychloroquine.

Adult↗
PubMed1988

Hydroxychloroquine and postoperative thromboembolism after total hip replacement.

Evidence for the usefulness of hydroxychloroquine as prophylaxis against thromboembolism after total hip replacement is examined. This agent causes reduction in red blood cell aggregation without prolonging the bleeding time in humans and, experimentally, reduces the size of the thrombus. There is a variably demonstrable reduction in platelet aggregation and blood viscosity in humans. After hip replacement, the venographic incidence of deep vein thrombosis is not influenced by hydroxychloroquine. The incidence of fatal pulmonary embolism appears to be reduced, but a controlled trial against placebo does not exist. There are no serious or irreversible side effects, and wound healing is not affected by the administration of this drug. Hydroxychloroquine remains the prophylaxis of choice in use at the Hip Center, Wrightington Hospital, England, 13 years after its introduction.

Biomechanical Phenomena↗
PubMed1993

Hydroxychloroquine sulfate (Plaquenil) improves oral lichen planus: An open trial.

BACKGROUND: Oral lichen planus is chronic and can be debilitating. Topical corticosteroids are most frequently used for treatment, but they are not always effective. OBJECTIVE: Hydroxychloroquine sulfate (Plaquenil), an antimalarial agent, was evaluated in an open trial (10 patients) for its ability to improve oral lichen planus. METHODS: Patients received hydroxychloroquine, 200 to 400 mg daily, as a monotherapy for 6 months. Patients were assessed at baseline and every 4 to 8 weeks during treatment. Baseline ophthalmologic examinations were performed, and laboratory values were monitored before and during treatment. RESULTS: Nine of ten patients had an excellent response to therapy. Three of six patients with erosions at baseline had complete healing. Pain relief and reduced erythema were usually observed after 1 to 2 months of therapy, but erosions required 3 to 6 months of treatment before they resolved. There were no adverse effects. CONCLUSION: Hydroxychloroquine may be useful in the treatment of oral lichen planus.

Administration, Oral↗
PubMed1991

High-performance liquid chromatographic separation of the enantiomers of hydroxychloroquine and its major metabolites in biological fluids using an alpha 1-acid glycoprotein stationary phase.

An enantioselective two-stage off-line assay has been developed for the analysis of hydroxychloroquine and its three major metabolites in biological fluids. The first non-stereoselective stage of the assay (PRP-1 column) separates and quantitates parent drug and metabolites. Fractions containing hydroxychloroquine and each of the metabolites are collected manually, evaporated, reconstituted in mobile phase and re-injected onto an alpha 1-acid glycoprotein column to separate and determine proportions of individual enantiomers. Preliminary results from patients samples indicate that the disposition of hydroxychloroquine and its major metabolites is enantioselective. p6

Body Fluids↗
PubMed2006

[Treatment of hydroxychloroquine poisoning with extracorporeal circulation].

We report a case of massive overdose of hydroxychloroquine treated with circulatory assistance by peripheral extracorporeal circulation (ECC). We expose the case of a 39-year-old woman who ingested 12 g of hydroxychloroquine with bromazepam, paroxetine, and zolpidem, in a suicide attempt. Patient has developed central nervous system depression, hemodynamic failure, life-threatening ventricular arrhythmias, and serious hypokalemia. Initially the patient has received conventional treatment with gastric lavage and activated charcoal for gastrointestinal decontamination, blood volume expansion and vasopressive drugs, intubation and mechanical ventilation, high dose of diazepam, and potassium replacement. A ventricular fibrillation was treated with external cardiac massage. In spite of this treatment, cardiogenic shock was uncontrolled, and imposed circulatory assistance. After extracorporeal circulation, we observed a spectacular improvement of hemodynamic parameters and electrocardiographic normalization at day one. Extracorporeal circulation could be used as a rescue treatment of cardiotrope and hydroxychloroquine overdoses.

Adult↗
PubMed2005

[Acute hydroxychloroquine poisoning. The danger of rapid or excessive correction of initial hypokalemia].

INTRODUCTION: Toxic effects of hydroxychloroquine, like chloroquine, include membrane stabilization and hypokalemia, which is correlated with the severity of the overdose. Correction of hypokalemia can expose patients to the risk of ventricular arrhythmia. CASE: A 19-year-old woman who had ingested 6 grams of hydroxychloroquine was admitted to intensive care with severe hypokalemia (1.5 mmol/L on admission). Thirty-six hours after correction of the hypokalemia, circulatory arrest followed ventricular fibrillation. Her potassium level at that time was 5.8 mmol/L. Outcome was favorable after it returned to normal. DISCUSSION: Because its pathogenesis remains debatable, the hypokalemia following hydroxychloroquine poisoning must be corrected with care, even when severe. This correction is difficult, and extracellular transfer of the excess potassium after elimination of the toxin exposes the patient to the risk of ventricular arrhythmia.

Adult↗
PubMed2005

Follow-up of infants exposed to hydroxychloroquine given to mothers during pregnancy and lactation.

OBJECTIVE: To determine the effect of hydroxychloroquine treatment during pregnancy and lactation on babies of mothers affected by rheumatic diseases. STUDY DESIGN AND METHODS: A total of 40 infants born from mothers affected by rheumatic diseases and treated with hydroxychloroquine during pregnancy were enrolled in a prospective observational study. Main outcome measures at birth were incidence of prematurity, congenital malformations and neonatal infections. Of these babies, including 13 who were breast-fed, 24 were followed up during early infancy for visual function and neurodevelopmental outcome. RESULTS: Preterm delivery was the main complication (20.5%). No significant congenital malformations or neonatal infections were detected. All infants, including those who were breast-fed, had normal visual function and neurodevelopmental outcome. CONCLUSIONS: Hydroxychloroquine treatment during gestation and lactation appeared to be safe. The relatively high incidence of preterm deliveries may reflect the maternal disease state.

Antirheumatic Agents↗
PubMed2003

Treatment of scleromyxoedema with hydroxychloroquine.

BACKGROUND: Scleromyxoedema is a rare disease of unknown aetiology that is characterized by deposition of mucin and sclerotic induration of the skin; it is associated with paraproteinaemia. Patients suffer from progressive disability due to immobilization and cosmetic disfigurement. Treatment of scleromyxoedema is a therapeutic challenge. The antimalarial hydroxychloroquine has a rapid and reliable effect in reticular erythematous mucinosis. PATIENTS AND METHODS: Four consecutive patients (two women, two men; median age: 50 years) with scleromyxoedema, three of them with IgG lambda paraprotein, were treated with hydroxychloroquine. Treatment was initiated with 600 mg p.o. for 10 days, followed by 400 mg for at least 4 weeks, and 200 mg thereafter. RESULTS: Complete remission of skin manifestations was achieved in one patient, whereas three patients achieved a partial remission of 61+, 5 and 25 months' duration. Notably, three patients felt increased mobility and reduced firmness of skin during the first week of treatment, which was reflected in a rapid reduction in dermal thickness. In one patient, dysphagia was reverted as evidenced by normalization of oesophageal clearance. Paraproteinaemia was not influenced at all. Side effects included one case of electroretinogram abnormalities after 19 months of therapy and one case of leucopenia after 3 months. CONCLUSION: Hydroxychloroquine is an effective form of therapy for scleromyxoedema, leading to rapid and prolonged alleviation of symptoms.

Adult↗
PubMed1994

Bioavailability of hydroxychloroquine tablets in patients with rheumatoid arthritis.

Nine patients with RA received two doses of 155 mg racemic hydroxychloroquine each, as a tablet and by i.v. infusion, in a randomized cross-over design study. Blood concentrations over the first 32 h following each dose were determined. Bioavailability was estimated using a sequential exponential least squares deconvolution method. The mean fraction absorbed from the tablet was 0.79 (range 0.39 to 1.27). The mean absorption lag-time was 1.3 h (range 0.5 to 3.7 h) and the mean time for 50% absorption was 4.3 h (range 1.9 to 10.3 h). Mean rate and extent of hydroxychloroquine absorption were not significantly different from that previously reported for healthy volunteers, although the interindividual variability in absorption parameters was greater in the patient group. Variability in the extent of absorption would lead to differences in steady-state hydroxychloroquine concentrations between patients, potentially contributing to the variability in response observed in clinical practice.

Adult↗