2018;85(6):459-67. 5 The earliest clinical signs associated with Plaquenil toxicity are subtle changes at the macula that may be visualized as fine pigmentary mottling. Recent studies have found connections between both RA and lupus and being at increased risk for problems with dental health. The most common signs and symptoms of Hydroxychloroquine overdose are drowsiness, nausea/vomiting, abdominal pain, visual/ auditory disturbances, agitation, respiratory/cardiac arrest, and . The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. But weight loss has been reported as a side effect. An example is chloroquine. The average milk level was of 376 mcg/L (array 20-1463 mcg/L) of Plaquenil and of 36 mcg/L (array 11-111 mcg/L) of desethylchloroquine. 2019;5(26). In extreme cases, they can be life-threatening. Reduced visual acuity occurs if fixation becomes involved.16, Irregularity of macular pigmentation and decreased foveal reflexes are the earliest retinal findings.16 A concentric, horizontally oval area of hypopigmentation develops greater inferiorly and surrounds the macular irregularity.16 The paracentral depigmentation develops into the characteristic bullseye maculopathy pattern which signifies advanced severe damage.16 Generalized pigmentary changes may progress for a minimum of three years with continued thinning of the fovea and loss of EZ length and architecture despite cessation of the drug making it difficult to distinguish from cone-rod dystrophy.14,16-18. They can recommend ways to maintain a weight thats healthy for you. If you have dizziness that doesnt ease, or you often have dizzy spells, contact your doctor to get this checked. Click here for more links and local resources. These articles might help: Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. Progression of hydroxychloroquine toxic effects after drug therapy cessation: new evidence from multimodal imaging. Stay with the person until professional help arrives. Chronic toxicity should be considered when conduction disorders (bundle branch block/AV heart block) or biventricular hypertrophy are diagnosed. But be sure to talk with your doctor first about how much to take. Psoriasis or porphyria. The mechanism to explain these clinical signs remains unclear. See the Plaquenil prescribing information for details. The following have been reported with PLAQUENIL overdosage: . Ear and labyrinth disorders: Vertigo , tinnitus , nystagmus, nerve deafness, deafness. This can include skin reactions such as: Although rare, these reactions are very serious and require treatment in a hospital. Hydroxychloroquine blood levels predict hydroxychloroquine retinopathy. 2015;56(5):3415-26. Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. Before starting Plaquenil, it is important to obtain a baseline, dilated eye examination with diagnostic testing from an ophthalmologist. 10. What are the more common side effects of Plaquenil? Serious side effects that have been reported and their symptoms include: If you know someone at immediate risk of self-harm, suicide, or hurting another person: If you or someone you know is having thoughts of suicide, a prevention hotline can help. Hydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines. Its not known how often they occur. 17. deSisternes L, Hu J, Rubin DL, Marmor MF. If cardiotoxicity is . To avoid this, make sure to take antacids or kaolin-containing products at least 4 hours before or after you take Plaquenil. In general, skin rash, pruritus, pigmentation disorders in skin and mucous membranes, bleaching of hair, and alopecia resolved readily when therapy was discontinued. No, you shouldnt. Mild side effects that have been reported with Plaquenil include: These side effects may be temporary, lasting a few days or weeks. You can also speak with your doctor or pharmacist. If you might be having heart-related side effects, theyll probably have you stop taking Plaquenil. Withdrawal symptoms are side effects that can happen when you stop taking a drug that your body is dependent on. It might. If youre concerned about Plaquenil and weight gain or weight loss, talk with your doctor. And some may be easily managed, too. Taking Plaquenil long term raises your risk of developing retinal damage. Five years after discontinuation showing loss of the IS-OS junction, outer nuclear layer and RPE. They may recommend a lower dose of the medication. Why does seasonal change affect my rheumatoid arthritis symptoms? Its usually a, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Its important to talk with your doctor about any skin reactions youre having, so that they can diagnose you. However, it is one of the leading causes of drug overdose in malaria prone countries and also the occasional toddler has managed to consume . Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, Ear or hearing problems, including deafness or. Laughter also releases endorphins the bodys natural painkillers. Arthritis Rheumatol. It is difficult to predict who will suffer from retinal toxicity, and just as difficult to catch the disease in its early (and therefore most treatable) stages. Chloroquine or hydroxychloroquine and/or azithromycin. Patients with retinal changes were asymptomatic initially or had scotomatous vision with paracentral, pericentral ring types, temporal scotomas, and abnormal color vision. Arch Rheumatol. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Are you dealing with a rheumatoid arthritis (RA) flare? No, its not likely. Psoriasis and lupus: What's the difference? For example, they may suggest using a moisturizer or mild steroid cream, or taking an antihistamine. Pre-existing retinal and macular disease makes accurate interpretation of the screening tests more challenging to identify early toxicity suggesting that HCQ use be avoided in these patients. You should always consult your doctor or another healthcare professional before taking any medication. Because of the risk for eye-related side effects, you should have an eye exam within 1 year of starting Plaquenil. Plaquenil can also damage your retina (a layer of light-sensitive cells in the back of the eye, which helps you see clearly). 2020;72(3):448-53. If you experience fever or other symptoms of illness, get medical help right away (especially while in the malarious area and for 2 months . Your doctor will help determine whether Plaquenil is safe for you to take. Although rare, Plaquenil usage can cause retinal toxicity that . Risk for Plaquenil retinal toxicity is minimal when: Risk for Plaquenil retinal toxicity if maximized when: All Plaquenil toxicity screening patients can expect an eye examination with visual acuity testing as well as a complete medical history to assist in the ophthalmologists assessment. But its not clear whether this side effect occurred in studies. 2018(20):133. Alcohol isnt known to interact with Plaquenil. Serious toxicity has been reported in patients with plasma levels ranging from 2.05 to 29.40 mcmol/L. 1. Plaquenil binds to retinal pigment cells, causing adverse changes in vision that occur slowly over time. Optical coherence tomography protocols for screening of hydroxychloroquine retinopathy in Asian patients. For example, taking higher doses of Plaquenil could raise your risk of certain eye-related and heart-related side effects. Or they may recommend trying another treatment for your condition. If you develop serious side effects while taking Plaquenil, call your doctor right away. Patients presenting with retinal toxicity can still noticed deterioration in visual function even after discontinuing hydroxychloroquine, possibly due to slow clearance from the retina and the rest of the body. 2008;28(10):1478-86. This includes increased risk for periodontal (gum) disease. Hydroxychloroquine retinal toxicity is far more common than previously considered; an overall prevalence of 7.5% was identified in patients taking HCQ for greater than 5 years, rising to almost 20 . Plaquenil is used to help control flare-ups in these medical conditions. We avoid using tertiary references. As reported by Marmor et al, the risk at this dosage is less than 1% up to 5 years, less than 2% up to 10 . Taking Plaquenil could cause red blood cells to burst in people who have G6PD deficiency (a lack of G6PD). Ahn, SJ, Joung J, Lee BR. (2021). And taking Plaquenil long term can raise your risk of certain side effects, such as retinal damage. But I think everyone taking Plaquenil needs to know the risks. These include damage to the retina, which is the light-sensitive tissue in the back of your eye. Fernandez AP. [Ref], Common (1% to 10%): Skin rash, pruritus, alopecia, Uncommon (0.1% to 1%): Pigmentary changes, pigmentation disorders in skin and mucous membranes, bleaching of hair, Rare (0.01% to 0.1%): Attacks of psoriasis, Very rare (less than 0.01%): Dermatitis bullous eruptions, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, photosensitivity, exfoliative dermatitis, acute generalized exanthematous pustulosis (AGEP), Frequency not reported: Urticaria, angioedema, Postmarketing reports: Hair color changes[Ref], Rare (0.01% to 0.1%): Exacerbation/precipitation of porphyria, Postmarketing reports: Hypoglycemia, decreased appetite, porphyria[Ref], Uncommon (0.1% to 1%): Dizziness, nerve deafness, vertigo, tinnitus, Rare (0.01% to 0.1%): Seizure/convulsions, neuromyopathy, Very rare (less than 0.01%): Nystagmus, ataxia, Postmarketing reports: Extrapyramidal disorders (e.g., dystonia, dyskinesia, tremor), deafness[Ref], Common (1% to 10%): Affect/emotional lability, Very rare (less than 0.01%): Psychosis, suicidal behavior, nightmares, Uncommon (0.1% to 1%): Abnormal liver function tests, Very rare (less than 0.01%): Fulminant hepatitis, Postmarketing reports: Acute/fulminant hepatic failure[Ref], Uncommon (0.1% to 1%): Sensorimotor disorders, Frequency not reported: Absent/hypoactive deep tendon reflexes, Postmarketing reports: Skeletal muscle myopathy/muscle weakness/neuromyopathy (leading to progressive weakness, atrophy of proximal muscle groups), depression of tendon reflexes, abnormal nerve conduction studies[Ref], Myopathy has been reversible after therapy discontinuation, but recovery has taken many months. These tests may include; visual field testing and multifocal ERG. Learn more about the symptoms here. Therefore, Plaquenil may affect the metabolism and function of the retinal pigment epithelial, or RPE cells. The Plaquenil, or hydroxychloroquine sulfate (HCQ) drug side effect may cause binding of melanin to the retinal pigment epithelium, or RPE layer of the retina. Ask your doctor what dosage of Plaquenil is recommended for your condition. A primary care provider or rheumatologist may prescribe Plaquenil to aid in treatment of multiple inflammatory diseases. Symptoms can be mild or serious and can include: For mild symptoms of an allergic reaction, call your doctor right away. "Product Information. G6PD is a protein that keeps your red blood cells healthy. Lumbar laminectomy is a surgery to treat spinal compression in your lower back. Plaquenil overdosage symptoms have an onset within 1-3 hours of ingestion. Plaquenil can cause mild or serious side effects. This quality enables the suppression of antigen presentations, along with the production of prostaglandin and cytokine.7 The drugs beneficial properties include antithrombotic, antifibrotic, antihyperglycemic, lipid reduction and immune suppressive properties.6,7 It lowers the risk of pregnancy complications in females who might require its use with systemic lupus erythematosus (SLE).6,8-10 Although the therapeutic is generally well tolerated, the adverse effects of HCQ include neuro-myotoxicity and cardiotoxicity in addition to its well-known risk for retinal toxicity.6,10. All rights reserved. Small amounts of Plaquenil can get into breast milk. Muscle or nerve problems. Dizziness can also be a symptom of some serious side effects of Plaquenil, such as low blood sugar and heart problems. Initially, central vision is not affected. Do my other medications raise my risk of side effects with Plaquenil? Kidney or liver problems. You can learn more about how we ensure our content is accurate and current by reading our. For example, tinnitus (ringing in your ears) or hearing loss caused by Plaquenil may not go away. Maculopathies and macular degeneration have been reported (onset ranging from 3 months to several years of exposure to this drug) and may be irreversible. Humphrey visual field (HVF) 10-2 showed defects in both eyes greater in the right than the left. But its not known for sure if its effective for this use. 5. AGEP has been associated with fever and hyperleukocytosis. 2,6 It is not retained in fatty tissue and is cleared predominantly by the kidneys (and to a lesser degree by the liver). If you have certain eye side effects, in particular retinal damage, youll need to stop taking Plaquenil. But some side effects could be long-term. Its main side effects are gastrointestinal upset (vomiting, diarrhea, stomach cramps), skin rash, headache, dizziness, and ocular toxicity [2]. Plaquenil (hydroxychloroquine)." Toxicity develops gradually and at different paces for different patients . Petri M, Elkhalifa M, Li J, et al. Melles RB, Marmor MF. Overdose signs could consist of frustration, sleepiness, vision adjustments, sluggish heart rate, breast pain or hefty feeling, discomfort infecting the arm or shoulder, nausea or vomiting, sweating, seizure (convulsions), superficial breathing, or breathing that stops. Psoriasis. Macular retinal ganglion cell-inner plexiform layer thickness in patients on hydroxychloroquine therapy. Knee bursitis is a swelling or inflammation of the bursa in the knee. 16. As the disease progresses, it begins to affect central vision and can become life-altering. Hydroxychloroquine may not prevent malaria in all cases. Rheumatoid arthritis can lead to gastrointestinal problems. To help prevent malaria, Plaquenil might be taken on a short-term or long-term basis. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. Neil Long. Overdose Signs What happens if I overdose on Hydroxychloroquine (Plaquenil)? And some medications used to treat RA or lupus, such as Trexall (methotrexate), can cause weight gain. Learn more about some of the side effects that Plaquenil may cause. Nirk EL, Reggiori F, Mauthe M. Hydroxychloroquine in rheumatic autoimmune disorders and beyond. These symptoms could be life threatening and require immediate medical care. O 0. Listen, but dont judge, argue, threaten, or yell. Damage to the retina can cause loss of vision that can be permanent. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Delivery TBD. High or low blood pressure. 8. This could cause a buildup of toxic blood levels of the drug. Hydroxychloroquine can modify the underlying disease process, rather than simply treating the symptoms. Some people may experience mild or serious side effects during Plaquenil treatment. I hesitated posting this because, unfortunately, I don't have a happy ending. If your doctor confirms you had a serious allergic reaction to Plaquenil, they may have you switch to a different treatment. Eye exams check for any damage to your retina and other problems with your vision. For this 55-year-old, a negative outcome was avoided through proper and timely screening and intervention. Talk with your doctor about which other treatments are better choices for you. Abdulaziz N, Shah AR, McCune WJ. They may recommend having blood tests more often than usual during treatment to monitor your liver health. You may be at higher risk if youve experienced this previously. Generally, your risk for side effects tends to increase as your Plaquenil dose increases. Note the incomplete bullseye maculopathy OD. If you have retinal damage, your doctor will monitor you closely after you stop treatment. If you have a GI condition such as UC, you may be at higher risk for these side effects. Pericentral retinopathy and racial differences in hydroxychloroquine toxicity. [2] While generally considered safe, several adverse effects of HCQ and CQ have been . MACULAR PUCKER TREATMENT Do not take any prescription drug, including Plaquenil, unless your doctor recommends that you do so. [Ref], Rare (0.01% to 0.1%): Cardiomyopathy (sometimes resulting in cardiac failure; some with fatal outcome), conduction disorders (bundle branch block/atrioventricular heart block), biventricular hypertrophy, Frequency not reported: Arrhythmia (torsade de pointes, ventricular tachycardia), Postmarketing reports: QT interval prolongation, ventricular arrhythmias, torsade de pointes[Ref], Common (1% to 10%): Blurred vision (including due to disturbance of accommodation), Uncommon (0.1% to 1%): Retinopathy (with changes in pigmentation, visual field defects), retinal changes (including paracentral, pericentral ring types, temporal scotomas, abnormal color vision), corneal changes (including edema, opacities), haloes, photophobia, Very rare (less than 0.01%): Extraocular muscle palsies, Frequency not reported: Maculopathies, macular degeneration, abnormal macular pigmentation and depigmentation (sometimes with bull's eye appearance), pallor of optic disc, optic atrophy, narrowing of retinal arterioles, Postmarketing reports: Irreversible retinopathy with retinal pigmentation changes (bull's eye appearance), visual field defects (paracentral scotomas), visual disturbances (visual acuity), maculopathies (macular degeneration), decreased dark adaptation, color vision abnormalities, corneal changes (edema, opacities), corneal deposition of drug with or without accompanying symptoms (halo around lights, photophobia, blurred vision[Ref]. Mild side effects that have been reported with Plaquenil include: nausea vomiting diarrhea * abdominal (belly) pain. Hallucinations and psychosis. If you have arthritis, you may wonder whether taking folic acid can help reduce hair loss with Plaquenil. But if you have lupus, youll likely need to take Plaquenil long term. Unfortunately, early symptoms are uncommon, and by the time suspicious vision changes begin to occur, the damage is usually permanent. 19. However, serious side effects including arrhythmia, bronchospasm, angioedema, and seizures can rarely occur. But its not known how often this side effect occurs. These side effects can be life threatening. Hydroxychloroquine (HCQ), a drug often used in the treatment of autoimmune diseases, has the potential to cause irreversible vision loss. A dilated fundus examination was remarkable for macular pigment mottling OU. Other OTC medications that can help relieve an upset stomach include antacids and kaolin (a type of clay used in some medications), but these can reduce how well Plaquenil works. Patients may experience: Plaquenil or Hydroxychloroquine retinopathy is most influenced by daily dose, length of use, and cumulative dosage over time. 2021;100(22):e25688. People who have liver disease may be at higher risk for this side effect, which could make your existing condition worse. Side effects havent been reported in children breastfed by people taking the drug. 2013;131(9):1187-97. Mititelu M, Wong BH, Brenner M, et al. 2018;30(3):249-255. 7. Plaquenil can cause dangerous effects on your heart, especially if you also use certain other medicines including the antibiotic azithromycin.
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