eMedicine Specialties > Ophthalmology > Unclassified Disorders

Chloroquine/Hydroxychloroquine Toxicity: Treatment & Medication

Author: Manolette R Roque, MD, MBA, DPBO, FPAO, President and CEO, Chief of Service, Ocular Immunology and Uveitis, Consulting Staff, Cornea and Refractive Surgery, Eye Republic Ophthalmology Clinic; General Manager, Ophthalmic Consultants Philippines Co; Consulting Staff, CME Liaison, Section Chief of Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center
Coauthor(s): Barbara L Roque, MD, Full Partner, Ophthalmic Consultants Philippines Co, Chief of Service, Pediatric Ophthalmology and Strabismus, Consulting Staff, Orbit and Eye Plastics, EYE REPUBLIC Ophthalmology Clinic; C Stephen Foster, MD, FACS, FACR, FAAO, Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution
Contributor Information and Disclosures

Updated: Apr 1, 2008

Treatment

Medical Care

  • Withdrawal of the medication and shifting to another form of treatment is the standard of care.
  • If serious toxic symptoms occur from overdosage or sensitivity, it has been suggested that ammonium chloride (8 g qd in divided doses for adults) be administered orally 3-4 times/wk for several months after therapy has been stopped.
    • Acidification of the urine increases renal excretion of the 4-aminoquinoline compounds by 20-90%.
    • In patients with impaired renal function and/or metabolic acidosis, caution must be taken.

Consultations

Coordination with the rheumatologist or the dermatologist is warranted for comprehensive care of the patient.

Medication

Withdrawal of the agent is the standard of care for patients who develop toxicity.

Diuretic, Miscellaneous

Acidification of urine increases renal excretion of 4-aminoquinoline compounds by 20-90%.


Ammonium chloride (Quelidrine)

Increases acidity of the urine by increasing free hydrogen ion concentrations. It is safe and easy to use.

Adult

8 g/d PO in divided doses 3-4 times/wk for several mo after administration of causative agents has been stopped

Pediatric

Not established

May reduce levels of aspirin, chlorpropamide, ephedrine, methadone, pseudoephedrine, spirolactone, and para aminosalicylic acid (PSA)

Documented hypersensitivity; severe hepatic and renal dysfunction; primary respiratory acidosis

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in hepatic and renal impairment

More on Chloroquine/Hydroxychloroquine Toxicity

Overview: Chloroquine/Hydroxychloroquine Toxicity
Differential Diagnoses & Workup: Chloroquine/Hydroxychloroquine Toxicity
Treatment & Medication: Chloroquine/Hydroxychloroquine Toxicity
Follow-up: Chloroquine/Hydroxychloroquine Toxicity
Multimedia: Chloroquine/Hydroxychloroquine Toxicity
References
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References

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Further Reading

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Keywords

chloroquine, hydroxychloroquine, Aralen, Plaquenil, bull's eye maculopathy, toxicity

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Contributor Information and Disclosures

Author

Manolette R Roque, MD, MBA, DPBO, FPAO, President and CEO, Chief of Service, Ocular Immunology and Uveitis, Consulting Staff, Cornea and Refractive Surgery, Eye Republic Ophthalmology Clinic; General Manager, Ophthalmic Consultants Philippines Co; Consulting Staff, CME Liaison, Section Chief of Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center
Manolette R Roque, MD, MBA, DPBO, FPAO is a member of the following medical societies: American Academy of Ophthalmic Executives, American Society of Cataract and Refractive Surgery, American Society of Ophthalmic Administrators, American Uveitis Society, International Ocular Inflammation Society, Philippine Medical Association, Philippine Ocular Inflammation Society, and Philippine Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Barbara L Roque, MD, Full Partner, Ophthalmic Consultants Philippines Co, Chief of Service, Pediatric Ophthalmology and Strabismus, Consulting Staff, Orbit and Eye Plastics, EYE REPUBLIC Ophthalmology Clinic
Disclosure: Nothing to disclose.

C Stephen Foster, MD, FACS, FACR, FAAO, Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution
C Stephen Foster, MD, FACS, FACR, FAAO is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association of Immunologists, American College of Rheumatology, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Royal Society of Medicine, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Kilbourn Gordon III, MD, FACEP, Urgent Care Physician, Primary Medical, Huntington Walk-In and Greenwich Convenient Medical Center
Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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