Annually, in the US around 2000 cases of malaria are diagnosed, and most of the cases are from travelers and immigrants from regions where malaria is highly prevalent. The prevention and treatment of malaria involves the use of one approved vaccine and various medications. One of the most commonly prescribed medication is Plaquenil, the branded version of Hydroxychloroquine. Following subsections offer a detailed look at the medication, its mechanism of action and the possibility of side effects of Plaquenil. This is intended to help users quickly identify the adverse outcomes and prevent or mitigate the effects. This will also help sections of users classified as unsuitable to take the medication to avoid the antimalarial drug and look at other suitable alternatives.

Overview of Plaquenil

Prescribed for the treatment of uncomplicated cases of malaria, Plaquenil is also used for chemoprophylaxis in a limited number of areas. The drug is also known to be used for the treatment of rheumatoid arthritis and lupus erythematosus due to its action as a disease modifying anti-rheumatic drug. Hydroxychloroquine, is essentially an aminoquinoline like chloroquine, and in areas where there is a probability of no resistance to chloroquine, the drug is also used for the prophylaxis of malaria. The medication was also recently considered and investigated as a treatment option for SARS-CoV-2, which was later discontinued when its emergency use was revoked by the FDA.

How Plaquenil works  

The medication belongs to a class of drugs that work by killing organisms responsible for malaria, and also by bringing about a reduction in the immune system activity. This gives the medication its use as treatment for specific auto immune conditions like lupus and rheumatoid arthritis. While it is still unclear about the exact manner in which the drug works, there are indications that point to the possible mechanism of action. Hydroxychloroquine is known to increase the pH in the vacuole of the malaria parasite and this in turn is known to impact the ability of the parasite grow and replicate. The drug is also known to affect the parasitic heme polymerase, apart from preventing antigen processing, and a reduction in the inflammatory response. By virtue of the increase in the pH in endosomes, the medication prevents various virus particles from entering into cells.

Conditions treated with Plaquenil

The following compilation lists out the various conditions treated with the drug. It is popular for its use in treating malaria, and as mentioned above is also used for malaria prophylaxis in areas where the possibility of resistance is lesser. It is used to treat certain autoimmune conditions such as rheumatoid arthritis and systemic lupus erythematosus. It is also prescribed for treating conditions such as collagen vascular disease, felty’s syndrome, rheumatoid lung, and cerner multum.

Categories of individuals unsuitable to take Plaquenil

Before we look at the possible side effects of Plaquenil, it is time to list out the categories of individuals who need to avoid the drug. Individuals with a history of allergies to hydroxychloroquine or chloroquine are to opt for a different line of treatment. The medication is known to cause some kind of impact on the retina, and this may affect individuals with existing eye conditions or kidney ailments. This is also known to impact individuals on Tamoxifen.

Individuals who have experienced some kind of vision related effects in the past after taking anti-malarial medication are to intimate the same to the doctor. Patients with pre-existing conditions such as heart disease, or any heart rhythm disorder are also part of the category of high-risk patients, who may not be suitable to receive the medication. Individuals with diabetes are also the intimate the doctor about the condition, apart from those with allergy to quinine and patients with liver/kidney ailments. Patients with chronic stomach conditions, or addiction to alcohol and patients diagnosed with psoriasis are also to convey the same to the doctor. This is necessary as the medication may impact in a different way, and it is essential to either change or modify dosage accordingly with suitable precautions.

Other conditions that need to be intimated

In addition, the above, patients are to intimate the treating specialist of the following conditions. For instance, patients with porphyria, and individuals with genetic enzyme deficiency are also to specifically inform the doctor before the Plaquenil is prescribed.  The possibility of impact of the medication on pregnant women has not been fully studied or documented, though malaria is known to have a serious impact on pregnant women.

It is also important for expectant mothers to specifically seek medical advice about the medication as there is little information about the effects on breast milk.

Commonly reported adverse effects of Plaquenil

All medications come with the probability of undesirable outcomes and Plaquenil is no exception. The actual effects may differ from person to person, with some experiencing mild or moderate effects while others are known to experience serious or adverse effects. It is also not necessary for all users of medications to experience side effects, with one section of users reportedly immune to any possible undesirable outcomes.

The mild or moderate effects are known to resolve naturally and may not require any medical intervention. These effects are relatively frequent or common in occurrence. The serious or adverse effects may require medical attention and are relatively rare in occurrence. Some of the strong effects need to be fixed or resolved fast, failing which there is the possibility of the condition turning serious. For instance, certain allergic reactions have the ability of quickly develop into serious conditions. This includes indications such as difficulty in breathing, or unusual swelling in the face, abnormal skin conditions and low-grade fever. Other conditions that are also indicative of a reaction include sore throat, pain on the skin, unusual burning sensation in the eyes, and sudden changes in the skin such as a reddish or purple appearance on the skin. This may or may not be accompanied by the formation of blisters and peeling of skin.

Other undesirable effects reported by patients

There is a possibility of the medication causing a lowering of blood sugar levels. This is presented through symptoms such as irritation that is not attributed to past behavior or any other medical condition. The individual may sweat profusely and may experience a headache apart from hunger. Any anxious feelings, or an increase in heart beat rate is also indicative of low blood sugar levels.

The medication is also known to cause serious and possibly irreversible damage to the eye. As outlined above, while this is known to typically affect individuals with pre-existing eye conditions and kidney ailments, it is also necessary for other patients to constantly look out for symptoms that are indicative of impact on the eyes. This includes blurred vision, difficulty in focusing, or unusual difficulties while reading. If the vision is either distorted, or if there are blind spots, it is indicative of an impact on the retina. Similarly, if there are changes in the ability to distinguish color, it is to be regarded as a change that needs to be diagnosed. Patients are known to observe halos around lights, and may also witness flashes of light, that are indicative of vision impact. Finally, the individual may also suddenly turn sensitive to light.

Side effects that are not a cause for concern

Certain undesirable outcomes are not a cause for concern, such as routine headaches and dizziness that is mild or short lived in nature. Individuals may also experience pain in the stomach apart from feelings of nausea and vomiting when on the medication. This may resolve quickly and without the need for treatment. A sudden loss of appetite or weight is also a possible outcome from the medication, and this is another condition that is not a cause for concern.

Indications that emergency treatment may be required

There are tell-tale indications that there may be a need for emergency treatment. For instance, individuals with symptoms that are consistent with heart ailments such as a rapid increase or decrease in heart beat rate or a fluttering sensation in the chest are to immediately seek emergency attention. Similarly, any shortness of breath or abnormal dizzy feelings are also to be regarded as serious that warrant attention. This could also be feelings wherein the individual apprehends that he or she is likely to have a black out.

Other symptoms that make it necessary to seek urgent medical attention includes a yellowish tinge to the eyes, a ringing sensation in the ears or any sudden or unusual hearing difficulty. Individuals who experience mood swings that have not been experienced earlier, are also to regard it is as possible effects that need to be monitored or treated. There is also the possibility of patients losing the ability to smoothly coordinate their movements, or may also experience muscle fatigue. Other conditions include a slowing of reflexes, and a reduction in blood cell count. This condition can be identified by trained healthcare workers by symptoms. For instance, fever is an indication of the condition, similarly, when the skin turns pale in appearance it indicates that there could be low blood cell count. The hands may be cold to the touch, and there is also the possibility of outbreak of sores in the mouth. Other symptoms include sore throat, and shortness of breath.

Side effects of Plaquenil – drug interactions

Medications come with the possibility of drug interactions; this is mainly because of a possible conflict in the mechanism of action of two medications taken together, or the properties of two medications. This could occur when prescription medications are taken along with other prescription medications, or OTC formulations, or herbal remedies, or health supplements. Individuals on medications are to understand the possibility of drug interactions and seek medical advice regarding use of different medications at the same time. Unlike side effects that may be experienced differently by different users, drug interactions are relatively common to all users.

The outcomes of drug interactions could be an increase in the desired outcomes or potency of either of the two medications, or a reduction in the efficacy of either of the two medications. It is also possible that the side effects of one or both the medications may be aggravated as a result of drug interactions. Plaquenil is known tin interact antacids or kaolin-pectin and specialists recommend that there should be a clear gap of four hours between the two medications. This will help reduce the possibility of interactions.

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