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Hydroxychloroquine (Plaquenil)

Hydroxychloroquine (Plaquenil) is used in the treatment and prevention of malaria, as well as in systemic diseases and diffuse connective tissue diseases. Plaquenil is the most famous of the active antimalarial drugs, which is included in the list of vital and essential drugs.

This is due to the fact that Hydroxychloroquine quickly destroys malaria pathogens and because it also has another effect: it suppresses an excessive immune response.
Hydroxychloroquine has the following properties:

• has an antiprotozoal effect – the drug suppresses the activity of protozoa, which are causative agents of various infections;
• has a moderate immunosuppressive effect – in autoimmune diseases – systemic lupus, discoid, certain areas of tissue are attacked by the body’s immune system, as they are mistakenly mistaken for foreign. Plaquenil suppresses this excessive response;
• the anti-inflammatory effect is becoming more widely used – hence the use of the drug for many types of joint pain, where conventional non-steroidal drugs have little effect.

Indications

Plaquenil (Hydroxychloroquine) is prescribed for a number of skin and autoimmune diseases, as the substance suppresses the activity of the immune system.

• Lupus erythematosus is systemic and discoid, which affects connective tissue and its derivatives, as well as blood vessels.
• Rheumatoid arthritis – including those associated with old age, a systemic disease of connective tissue with a mechanism similar to autoimmune diseases.
• Rheumatism of the heart.
• Systemic scleroderma.
• Malaria – excluding those forms of the disease where the causative agents are strains resistant to the action of chlorins. It is used both as a therapeutic and as a prophylactic agent.
• Skin diseases – particularly those caused or aggravated by sun exposure. These are all types of photodermatoses: solar prurigo, photophytodermatitis, solar urticaria, light eczema, phototoxic dermatitis, and so on. They are associated with excessive skin sensitivity to ultraviolet radiation. Instead of the usual mechanism of melanin production under the influence of sunlight, with such ailments, a variety of unexpected chemical reactions occur, leading to skin damage.

An aggravating factor in photodermatitis is the body’s own immune reaction, which perceives damaged areas of the skin as foreign and seeks to destroy them.

The immunosuppressive effect of the substance allows you to suppress allergic and inflammatory reactions and cure dermatitis.

Contraindications

Plaquenil has quite a few contraindications, as it creates a significant burden on the kidneys and liver. In addition, hydroxychloroquine causes and markedly worsens visual disturbances.

The main direct contraindications include:

• pregnancy – use is allowed only when absolutely necessary;
• excessive sensitivity to 4-aminochlorins and its derivatives;
• hereditary lactose intolerance, as well as deficiency of this enzyme, galactosemia, etc. The limitation is due to lactose in the composition of the medicine;
• underweight – children weighing less than 31 kg, that is, up to almost 6 years of age, the drug is not prescribed;
• retinopathy – damage to the retina;
• childhood – is a contraindication if long-term therapy is necessary since the risk of developing toxic effects is too high.

Plaquenil should be prescribed very carefully for visual disorders:

• decreased severity;
• impaired light perception;
• narrowing of the visual field;
• when using medications that also provoke ophthalmic manifestations.

Before prescribing medication, an eye examination is required. Visual acuity, light perception are assessed, and the condition of the fundus is determined. During long-term therapy, the examination is repeated at least once every six months.

There are a number of pathologies for which the use of the drug may be inappropriate. In each such case, the doctor must evaluate the actual risks and benefits of using hydroxyl chlorine:

• severe gastrointestinal disorders;
• cutaneous porphyria – there is a risk of exacerbation;
• renal or liver failure, including while taking nephrotoxic drugs. If there is a need, the dose is selected by monitoring the concentration of hydroxychloroquine in plasma;
• hematological diseases, including anemia;
• lack of glucose-6-phosphate dehydrogenase;
• high general sensitivity to quinine;
• The drug is not prescribed for severe mental disorders – psychosis, for example;
• psoriasis – skin manifestations may noticeably intensify. You should also be careful if you are taking a medication that may cause skin rashes at the same time.

Side effects

The greatest concern is caused by changes in the organs of vision: some of them are asymptomatic. If the transformations have not crossed a certain limit, they disappear after the end of the course of treatment.

However, the risk of progression of vision defects remains.

There is a clouding of the cornea, swelling, visual acuity decreases, halos, and fear of light appear. Most often, the changes are reversible.

Possible skin rashes, itching, changes in skin color, and hair discoloration. These symptoms disappear after completing the course. In rare cases, acute exanthematous pustulosis is observed, which must be distinguished from psoriasis since the drug also enhances the manifestations of the latter.

The gastrointestinal tract may cause anorexia, diarrhea, pain, and sometimes vomiting. When the dose is reduced or discontinued, the symptoms disappear.

Dizziness, hearing loss, tinnitus, and headaches are uncommon. Weakness, atrophy of muscle groups, and suppression of tendon reflexes may appear. All changes are reversible.

Changes in the cardiovascular system are observed much less frequently – cardiomyopathy, conduction disturbances, and possible inhibition of hematopoietic functions. Cases of anemia, leukopenia, and thrombocytopenia have been reported.