Hydroxychloroquine Sulphate interactions

Food & lifestyle

• grapefruit juice

  Moderate

  Metabolism

  Theoretically, grapefruit and grapefruit juice may increase the plasma concentrations of hydroxychloroquine or chloroquine and the risk of toxicities such as QT interval prolongation and ventricular arrhythmias. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruit.

  What to do: Although clinical data are lacking, it may be advisable to avoid the consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract during hydroxychloroquine or chloroquine therapy.

  1 source

  1. Cerner Multum, Inc. "Australian Product Information." O 0

Conditions

Conditions in which Hydroxychloroquine Sulphate needs care, as documented in this source.

• Porphyrias

  Major

  The use of aminoquinolines in patients with porphyria may exacerbate the condition. Aminoquinolines should not be used in these patients unless the potential benefits are anticipated to outweigh the risks.

  3 sources

  1. "Product Information. Aralen (chloroquine)." Sanofi Winthrop Pharmaceuticals (2002):
  2. Liu AC "Hepatotoxic reaction to chloroquine phosphate in a patient with previously unrecognized porphyria cutanea tarda." West J Med 162 (1995): 548-51
  3. "Product Information. Plaquenil (hydroxychloroquine)." Apothecon Inc (2022):

• Toxic Optic Neuropathy

  Major

  The use of 4-aminoquinolines is generally considered contraindicated in the presence of retinal or visual field changes, whether attributable to 4-aminoquinoline compounds or to any other etiology. However, in the treatment of acute attacks of malaria caused by susceptible strains of plasmodia, these agents may be considered if potential benefits are anticipated to outweigh the risks. 4-aminoquinolines are oculotoxic and can cause dose-related, irreversible retinal damage and vision loss during and up to several years after long-term or high-dose therapy (e.g., in the treatment of systemic lupus erythematosus or rheumatoid arthritis). Ophthalmologic monitoring, including visual acuity, expert slit-lamp, funduscopic, and visual field tests, is recommended at baseline and every three months during prolonged use. Therapy should be discontinued immediately if abnormalities develop in visual acuity, visual field, or retinal macular areas (e.g., pigmentary changes, loss of foveal reflex), or if the patient experiences visual symptoms such as light flashes and streaks that are not fully explainable by difficulties of accommodation or corneal opacities. Other common symptoms that may indicate retinopathy include nyctalopia, photophobia, blurred distance vision, difficulty reading or seeing (e.g., words or letters disappearing or parts of objects missing; misty vision; fog before the eyes), and missing or blacked out areas in the central or peripheral visual field. Retinal changes and visual disturbances may progress even after cessation of therapy. However, in a number of patients, early retinopathy (macular pigmentation sometimes with central field defects) diminished or regressed completely after therapy was discontinued. Paracentral scotoma to red targets, sometimes termed premaculopathy, is indicative of early retinal dysfunction and is usually reversible with cessation of therapy.

  8 sources

  1. Sassani JW, Brucker AJ, Cobbs W, Campbell C "Progressive chloroquine retinopathy." Ann Ophthalmol 15 (1983): 19-22
  2. Ehrenfeld M, Nesher R, Merin S "Delayed-onset chloroquine retinopathy." Br J Ophthalmol 70 (1986): 281-3
  3. Frisk-Holmberg M, Bergkvist Y, Domeij-Nyberg B, et al. "Chloroquine serum concentration and side effects: evidence for dose-dependent kinetics." Clin Pharmacol Ther 25 (1979): 345-50
  4. Craig GL, Buchanan WW "Antirheumatic drugs: clinical pharmacology and therapeutic use." Drugs 20 (1980): 453-84
  5. "Product Information. Aralen (chloroquine)." Sanofi Winthrop Pharmaceuticals (2002):
  6. Goldstein JH "Effects of drugs on cornea, conjunctiva, and lids." Int Ophthalmol Clin 11 (1971): 13-34
  7. "Product Information. Plaquenil (hydroxychloroquine)." Apothecon Inc (2022):
  8. Puavilai S, Kunavisarut S, Vatanasuk M, Timpatanapong P, Sriwong ST, Janwitayanujit S, Nantiruj K, Totemchokchyakarn K, Ruangkanchana "Ocular toxicity of chloroquine among Thai patients." Int J Dermatol 38 (1999): 934-7

• Arrhythmias, Cardiac

  Moderate

  The use of 4-aminoquinolines such as hydroxychloroquine and chloroquine prolong the QT interval. Ventricular arrhythmias and torsades de pointes have been reported in patients taking these agents. Care should be exercised in patients with a prolonged QT interval at baseline or at increased risk for arrythmia. A baseline electrocardiogram should be obtained to assess for QT interval prolongation and other abnormalities. It is recommended to use appropriate diagnostic tools such as ECG to monitor patients during therapy.

  1 source

  1. "Product Information. Plaquenil (hydroxychloroquine)." Apothecon Inc (2022):

• Bone Marrow Failure Disorders

  Moderate

  Adverse hematologic effects including neutropenia, agranulocytosis, aplastic anemia, and thrombocytopenia have been rarely associated with 4-aminoquinolines. Therapy with 4-aminoquinolines should be administered cautiously in patients with preexisting bone marrow suppression. A complete blood count should be performed periodically in patients on prolonged therapy. If any severe blood disorder appears which is not attributable to the disease under treatment, discontinuance of the drug should be considered.

  4 sources

  1. "Product Information. Aralen (chloroquine)." Sanofi Winthrop Pharmaceuticals (2002):
  2. Polano MK, Cats A, van Olden GAJ "Agranulocytosis following treatment with hydroxychloroquine sulphate." Lancet 1 (1965): 1275
  3. Winkelman RK, Merwin CF, Brunsting LA "Antimalarial therapy of lupus erythematosus." Ann Intern Med 55 (1961): 772-6
  4. "Product Information. Plaquenil (hydroxychloroquine)." Apothecon Inc (2022):

• Diabetes Mellitus

  Moderate

  Hydroxychloroquine has been shown to cause severe hypoglycemia including loss of consciousness that could be life threatening in patients treated with or without antidiabetic. Care should be exercised when using hydroxychloroquine in diabetic patients. Patients presenting with clinical symptoms suggestive of hypoglycemia during treatment with hydroxychloroquine should have their blood glucose checked and treatment instituted as necessary.

  1 source

  1. "Product Information. Plaquenil (hydroxychloroquine)." Apothecon Inc (2022):

• Glucosephosphate Dehydrogenase Deficiency

  Moderate

  Hemolysis and acute renal failure have been reported during use of aminoquinolines in patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. Therapy with aminoquinolines should be administered cautiously in these patients. Blood cell counts and hemoglobin determinations should be performed regularly. Aminoquinoline therapy should be discontinued immediately if signs suggestive of hemolytic anemia occur, such as marked darkening of the urine or sudden decrease in hemoglobin concentration or erythrocytic count.

  2 sources

  1. "Product Information. Aralen (chloroquine)." Sanofi Winthrop Pharmaceuticals (2002):
  2. "Product Information. Plaquenil (hydroxychloroquine)." Apothecon Inc (2022):

• Heart Diseases

  Moderate

  Cardiomyopathy has been rarely reported with high daily dosages of hydroxychloroquine. Therapy with hydroxychloroquine should be monitored in patients with heart conditions. If cardiotoxicity is suspected, it is recommended to discontinue treatment with hydroxychloroquine to prevent life-threatening complications.

  1 source

  1. "Product Information. Plaquenil (hydroxychloroquine)." Apothecon Inc (2022):

• Kidney Diseases

  Moderate

  Hydroxychloroquine is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. A dosage adjustment is not required for patients with renal impairment. Caution and monitoring should be exercised in patients with impaired renal function.

  1 source

  1. "Product Information. Plaquenil (hydroxychloroquine)." Apothecon Inc (2022):

• Liver Diseases

  Moderate

  Aminoquinolines may concentrate in the liver. Isolated cases of abnormal liver function and fulminant hepatic failure have been reported. Therapy with aminoquinolines should be administered cautiously in patients with hepatic disease or alcoholism and in patients receiving other hepatotoxic drugs. Periodic evaluation of hepatic function should be performed during prolonged therapy.

  4 sources

  1. "Product Information. Aralen (chloroquine)." Sanofi Winthrop Pharmaceuticals (2002):
  2. Liu AC "Hepatotoxic reaction to chloroquine phosphate in a patient with previously unrecognized porphyria cutanea tarda." West J Med 162 (1995): 548-51
  3. "Product Information. Plaquenil (hydroxychloroquine)." Apothecon Inc (2022):
  4. Grossman I, Azaz-Livshits T, Fridlender Z, Muszkat M, Ben-Chetrit E "Mefloquine-induced acute hepatitis." Pharmacotherapy 20 (2000): 1517-9

• Myasthenia Gravis

  Moderate

  Certain aminoquinolines such as chloroquine, and hydroxychloroquine should be used with caution in patients with myasthenia gravis (MG). These agents may exacerbate or trigger new onset of symptoms in patients with previously diagnosed MG. It is recommended to advise patients with MG about this possible side effect.

  2 sources

  1. "Product Information. Aralen (chloroquine)." Sanofi Winthrop Pharmaceuticals (2002):
  2. "Product Information. Plaquenil (hydroxychloroquine)." Apothecon Inc (2022):

• Ototoxicity

  Moderate

  The use of 4-aminoquinolines has been associated rarely with ototoxicity. Nerve-type deafness, which is usually irreversible, has occurred during long-term, high-dose therapy. Deafness may not be apparent until several weeks after 4-aminoquinoline therapy. Tinnitus and reduced hearing have been reported in patients with preexisting auditory damage. Therapy with 4-aminoquinolines should be administered cautiously in such patients. If new auditory defects develop or if hearing loss becomes worse, therapy should be immediately discontinued and the patient closely monitored.

  2 sources

  1. "Product Information. Aralen (chloroquine)." Sanofi Winthrop Pharmaceuticals (2002):
  2. "Product Information. Plaquenil (hydroxychloroquine)." Apothecon Inc (2022):

• Psoriasis

  Moderate

  The use of aminoquinolines in patients with psoriasis may precipitate a severe attack of psoriasis. Aminoquinolines should not be used in these patients unless the potential benefits are anticipated to outweigh the risks.

  7 sources

  1. Olsen TG "Chloroquine and psoriasis." Ann Intern Med 94 (1981): 546-7
  2. Mallett R "Risks and benefits of prophylactic antimalarial drugs." Br Med J 299 (1989): 1400
  3. Okor RS "Onset of pruritogenicity of chloroquine and the implication for the timing of suppressive therapy." J Clin Pharm Ther 16 (1991): 463-5
  4. Kuflik EG "Effect of antimalarial drugs on psoriasis." Cutis 26 (1980): 53-5
  5. Vestey JP, Savin JA "Psoriasis worsened by antimalarial prophylaxis." J Infect 24 (1992): 211-2
  6. "Product Information. Aralen (chloroquine)." Sanofi Winthrop Pharmaceuticals (2002):
  7. "Product Information. Plaquenil (hydroxychloroquine)." Apothecon Inc (2022):

• Seizures

  Moderate

  4-aminoquinolines may cause epileptic seizures in susceptible individuals. Patients with epilepsy or an otherwise low seizure threshold may be at greater risk. Therapy with 4-aminoquinolines, particularly chloroquine, should be administered cautiously in patients with epilepsy.

  5 sources

  1. Fish DR, Espir ML "Convulsions associated with prophylactic antimalarial drugs: implications for people with epilepsy." Br Med J 297 (1988): 526-7
  2. "Product Information. Aralen (chloroquine)." Sanofi Winthrop Pharmaceuticals (2002):
  3. Mulhauser P, Allemann Y "Chloroquine and nonconvulsive status epilepticus." Ann Intern Med 123 (1995): 76-7
  4. "Product Information. Plaquenil (hydroxychloroquine)." Apothecon Inc (2022):
  5. Benbadis SR, Vanness PC "Chloroquine and nonconvulsive status epilepticus." Ann Intern Med 124 (1996): 614

Therapeutic duplication

Drug classes that overlap with Hydroxychloroquine Sulphate, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• antimalarials

  The recommended maximum number of medicines in the 'antimalarials' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'antimalarials' category.

  Example product in the source data (US market): Coartem