Plaquenil


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Related to Plaquenil: methotrexate, Lupus

Plaquenil

 [pla´kwĕ-nil]
trademark for a preparation of hydroxychloroquine, an antiinflammatory and antiprotozoal agent used for treatment of malaria, lupus erythematosus, rheumatoid arthritis, and giardiasis.

hydroxychloroquine sulfate

Apo-Hydroxychloroquine (CA), Gen-Hydroxychloroquine (CA), Plaquenil

Pharmacologic class: 4-aminoquinolone

Therapeutic class: Antimalarial, antirheumatic, anti-inflammatory (disease-modifying)

Pregnancy risk category C

FDA Box Warning

• Familiarize yourself completely with contents of the manufacturer's package insert before administering or prescribing this drug.

Action

Unknown. Thought to interfere with inhibition of protein synthesis and DNA replication, leading to parasitic death.

Availability

Tablets: 200 mg (155 mg base); 200 mg hydroxychloroquine sulfate is equivalent to 155 mg of hydroxychloroquine base

Indications and dosages

Malaria prophylaxis (dosages expressed as mg of base)

Adults: 310 mg P.O. q week, starting 1 to 2 weeks before entering endemic area and continuing for 4 weeks after leaving area

Children: 5 mg/kg P.O. q week, starting 1 to 2 weeks before entering endemic area and continuing for 4 weeks after leaving area

Acute malarial attack (dosages expressed as mg of base)

Adults: Initially, 620 mg P.O., then 310 mg 6 hours, 24 hours, and 48 hours later

Children: Initially, 10 mg/kg P.O., then 5 mg/kg 6 hours, 24 hours, and 48 hours later

Rheumatoid arthritis

Adults: 400 to 600 mg/day P.O. for 4 to 12 weeks, then reduced by 50%

Systemic lupus erythematosus

Adults: 400 mg P.O. once or twice daily for several months, then reduced to 200 to 400 mg daily, depending on response

Contraindications

• Hypersensitivity to drug or chloroquine
• Retinal or visual field changes
• Long-term therapy in children

Precautions

Use cautiously in:
• hepatic or renal impairment, G6PD deficiency, psoriasis, bone marrow depression, alcoholism
• obese patients
• pregnant or breastfeeding patients
• children.

Administration

• Give with food or milk.
• For malaria prophylaxis, schedule doses on same day each week.

Adverse reactions

CNS: anxiety, apathy, confusion, fatigue, headache, psychoses, mood swings, irritability, neuromyopathy, peripheral neuritis, seizures

CV: ECG changes, hypotension

EENT: visual disturbances, retinopathy, keratopathy, ototoxicity, tinnitus

GI: nausea, vomiting, diarrhea, abdominal cramps, anorexia

Hematologic: leukopenia, agranulocytosis, aplastic anemia, thrombocytopenia

Hepatic: jaundice, hepatotoxicity

Musculoskeletal: muscle weakness

Skin: dermatoses, rash, pruritus, pigmentation changes, pleomorphic skin eruption, worsened psoriasis, alopecia, bleaching of hair

Other: weight loss

Interactions

Drug-diagnostic tests.Granulocytes, hemoglobin, platelets: decreased values

Drug-behaviors.Sun exposure: exacerbation of drug-induced dermatoses

Patient monitoring

Monitor for signs and symptoms of overdose, such as nausea, vomiting, drowsiness, visual disturbances, cardiovascular collapse, and seizures.
• Watch for adverse reactions.

Patient teaching

• Advise patient to take with food or milk.

Instruct patient to immediately report such adverse reactions as vision changes, nausea, vomiting, drowsiness, mental changes, mood swings, headache, ringing in ears, muscle weakness, rash, bleeding, bruising, and yellowing of skin and eyes.
• In long-term therapy, advise patient to have regular eye exams.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

Plaquenil

(plăk′wə-nĭl)
A trademark for the drug hydroxychloroquine sulfate.

Plaquenil ®

Hydroxychloroquine sulfate, see there.

Plaquenil

A brand name for HYDROXYCHLOROQUINE.
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The patient also began taking penicillamine, a disease-modifying drug, along with prednisone and Plaquenil.
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Response to treatment is variable but patients may respond to steroids, plaquenil, methotrexate, D-penicillamine, and cimetidine.
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Plaquenil, Flagyl, or Tindamax may be added along with a cell-wall drug and intracellular drug in order to address the cyst form of the infection.
Service members returning from Afghanistan will receive malaria terminal chemoprophylaxis, typically Plaquenil.
Six months later she remains symptom free on 5 mg of prednisone and Plaquenil 400 mg daily.
In addition, patients on Benlysta tend to use significantly less Plaquenil, NSAIDs, and CellCept than non-Benlysta users.
Over the course of three years, he received intravenous antibiotics that included Rocephin, Merrem, Zithromax, Plaquenil, Claforan, Amoxycillin, Doxycyclin, and supportive nutritional supplements.
While surveyed rheumatologists suggest that Benlysta is most likely to replace Rituxan or Cytoxan, actual patient origination in close to 60% of Benlysta patients have been following Plaquenil failure or a single immunosuppressant failure.
After steroids, physicians are often left with methotrexate, Plaquenil, allopurinol, and others.
This category includes gold, sulfasalazine, methotrexate, Plaquenil (hydroxycholoroquine), prednisone, leflunomide, as well as several inhibitors of tumor necrosis factor, including infliximab, etanercept, and the newly approved anakinra.