Current Drug Therapy

Hydroxychloroquine: An old drug with new relevance

Eugen Alexander Shippey, MD, Vanya D. Wagler, DO, FACP, FACR and Angelique N. Collamer, MD, FACP, FACR
Cleveland Clinic Journal of Medicine June 2018, 85 (6) 459-467; DOI: https://doi.org/10.3949/ccjm.85a.17034

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Chronic facial skin hyperpigmentation in a patient with a lifetime hydroxychloroquine dose of 2,000 g. Hyperpigmentation and retinopathy may occur independently of each other, but a high cumulative medication dose is a risk factor for both conditions.

Tables

  • TABLE 1

    Recommended screening for retinopathy in patients on hydroxychloroquine

    Low-risk patientsPatients with risk factorsa
    Initial screeningWithin first year of therapyWithin first year of therapy
    Repeat screeningAfter 5 years of therapy, then annuallyAnnually

    • ↵a Higher medical dose, decreased renal function, tamoxifen use, or macular disease.

    • Based on information in references 27 and 28.

  • TABLE 2

    Antimalarial dosing

    Hydroxychloroquine≤ 5.0 mg/kg/day real body weight, but no more than 400 mg total daily dose
    Chloroquine≤ 2.3 mg/kg/day real body weight

    • Based on information in reference 28.

  • TABLE 3

    Considerations before hydroxychloroquine use

    Measure glucose-6 phosphate dehydrogenase if indicated
    Take ocular history and order baseline ophthalmologic evaluation
    Screen for digoxin use
    Screen for history of cardiomyopathy or severe heart failure
    Counsel patient on risks of use, including permanent loss of vision and recommended frequency of screening retinal examination
    Counsel on risks of skin rashes, gastrointestinal upset, increased hair and skin pigmentation
    Obtain baseline laboratory testing
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools

Jump to section

Subjects