HYDROXYCHLOROQUINE TREATMENT

BSR Guideline 2004

DOSAGE

Initiation: 400 mg daily until response

Maintenance: 200 mg daily

Maximum dosage: 6.5 mg/kg/day

It is more palatable after food. Orange juice may mask the bitter after taste.

MONITORING PROCEDURE

Base line assessment only - U&E and LFT

Enquiries about visual impairment and recording of near visual acuity will be done in the Rheumatology Clinic with yearly evaluations thereafter. If visual impairment is present at baseline, assessment by an optomotrist is advised.

Referral to Ophthalmologistist is appropriate if:

1. Visual impairment/eye disease detected at baseline confirmed by optomotrist

2. Change in acuity or blurred vision whilst on treatment

(Stop treatment until assessed)

3. Children

Contraindications

Pregnancy, pre-existing maculopathy. It must not be co-prescribed with Amiodarone (risk of ventricular arrhythmia’s)

Cautions

Liver and kidney disease, and in sever GI, neurological and blood disorders.

Interactions

Amiodarone (see contraindications)

Antacids reduce its absorption

Antagonism of anticonvulsant effect

Increase plasma concentration of Digoxin

Increased risk of Cyclosporin toxicity if co-prescribed

Side Effects

Common effects are in bold type

Mucocutaneous - pruritis erythematous rash seen after treatment commenced.

Blue-black pigmentation of skin

Haematological - thrombocytopenia, agranulocytosis (very rare)

Gastrointestinal - NAUSEA, DIARRHOEA, abdominal cramps

Ocular - Cycloplegia, keratopathy (reversible), irreversible retinopathy

/maculopathy, photophobia – advise sunglasses in bright

light

Other - headache, bleaching of skin/hair, proximal myopathy,

peripheral neuropathy