Hydroxychloroquine impedes the innate immune response via decreased activation of B-cells. Neutrophils and eosinophils are also inhibited with this medication. For this reason, hydroxychloroquine is useful in hyperimmune or autoimmune diseases.
Hydroxychloroquine is used for the treatment of uncomplicated malaria caused by Plasmodium species and for prophylaxis of malaria in geographic areas where chloroquine resistance is not present. The medication interferes with the acidic digestive vacuoles within the parasites that lead to their death via damage to membranes and other critical biomolecules.
Hydroxychloroquine is used for treatment in adults with acute and chronic rheumatoid arthritis. This autoimmune disease causes an inflammatory response most commonly found in the joints of the hands, feet, wrists, elbows, knees, and ankles. This medication is used to decrease inflammation and the immune response that lead to common symptoms such as joint pain and swelling.
Hydroxychloroquine is used for the treatment of systemic lupus erythematosus (SLE) and chronic discoid lupus in adults. These are both autoimmune diseases, thus hydroxychloroquine can help quell the inflammation and subsequent symptoms.
Hydroxychloroquine, given twice weekly, is used for porphyria cutanea tarda either for initial therapy or an alternative when phlebotomies are difficult to perform. It's an appropriate choice in patients with serum ferritin <600ng/mL, heterozygosity or no HFE mutation.
Cardiomyopathy is reported during acute and chronic therapy with HCQ. Monitor for signs and symptoms of cardiotoxicity including atrioventricular block, pulmonary hypertension, sick sinus syndrome, QT prolongation, or other EKG findings. If a patient presents with these clinical findings, immediate discontinuation of hydroxychloroquine is recommended.
Hydroxychloroquine has been associated with retinopathy that can cause permanent damage. The risk of retinopathy is correlated with dose and duration of use. On fundoscopy, a “bullseye” appearance of the macula is an indication of serious hydroxychloroquine-associated retinotoxicity. This medication can also cause corneal damage such as cornea verticillata which are whorl-like deposits can form on the cornea. The corneal damage is often reversible upon discontinuation of the drug.
Due to the risk of retinopathy, a baseline ophthalmologic exam within 1 year of initiating therapy is recommended. If no major risk factors exist, first screening can be postponed until 5 years after initiation of therapy. Since any damage to the retina is irreversible, early detection is key to preventing progressive damage or any visual loss. The exam will typically consist of documentation of functional status, fundus evaluation, or changes in ocular conditions.
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