pharmachologic effect
Plaquenil has the following effects:
- Antiprotozoal - suppress the vital activity of protozoa that cause infectious diseases. First of all, this concerns pathogens of malaria , so the main effect of the drug is antimalarial.
- Immunosuppressive – suppresses an overreaction of the immune system, including allergies to the patient’s own tissues.
- Anti-inflammatory – suppresses inflammatory reactions.
Pharmacodynamics and pharmacokinetics
Plaquenil belongs to the group of antimalarial and immunosuppressive drugs from the group of 4-aminoquinoline . The mechanism of its action is not well understood, but it is believed that it is associated with the following properties of this drug:
- The ability to suppress the action of toxic free radicals formed during metabolism (antioxidant effect).
- The ability to suppress the action of enzymes that cause the breakdown of cartilage tissue.
- The ability to suppress the synthesis of prostaglandins - biologically active substances involved in inflammatory processes.
- The ability to concentrate in leukocytes and strengthen the membranes of lysosomes - cell structures containing enzymes that can break down nutrients entering the cell. Lysosomes are also involved in the digestion of bacteria captured by leukocytes.
- The ability to suppress the synthesis of those types of cytokines (hormone-like proteins synthesized by cells to influence other cells) that activate the immune system. This also helps to reduce autoimmune processes (destruction of the body’s own tissues by immune processes).
- The ability to suppress the activity of lymphocytes involved in immune reactions.
- The ability to suppress the formation of rheumatoid factor - immunoglobulins (antibodies) that perceive the body's own tissues as foreign structures ( antigens ) and destroy them.
- The antimalarial properties of Plaquenil consist in suppressing the vital activity of pathogens of tertian malaria , quartan malaria, malaria ovale, as well as forms of tropical malaria pathogens that are sensitive to it (most pathogens of tropical malaria are insensitive to Plaquenil).
After taking a Plaquenil tablet, its active substance is quickly and almost completely absorbed and enters the blood, and then accumulates in high concentrations in various organs and tissues. The maximum concentration of the active substance in the blood plasma is achieved within approximately 100 minutes. The drug is decomposed in the liver into active and inactive metabolic products ( metabolites ) and is excreted in the urine, but partially also in feces. The active substance Plaquenil crosses the placenta and is excreted in human milk. The drug is excreted slowly; it disappears from the blood plasma no earlier than after a month.
Indications for use of Plaquenil
Due to the fact that Plaquenil suppresses immune (including autoimmune) and inflammatory reactions, it is used to treat:
- rheumatoid arthritis;
- juvenile rheumatoid arthritis;
- systemic lupus erythematosus;
- discoid lupus erythematosus.
Plaquenil is used to treat and prevent acute attacks of three-day malaria, four-day malaria, malaria ovale, as well as tropical malaria caused by strains of malarial plasmodium . Plaquenil is also used for the purpose of complete cure for tropical malaria caused by strains of malarial plasmodium sensitive to this drug.
Doctors have expressed conflicting opinions about the possible therapeutic effectiveness of Plaquenil for coronavirus infection COVID-19 . The French doctor Didier Rault conducted a study in which patients taking Plaquenil had a greatly reduced viral load after 6 days of treatment. When Plaquenil is taken in combination with Azithromycin, an increase in antiviral effect is observed. However, medical experts talk about the possibility of serious side effects and prohibit taking medications with hydroxychloroquine without a doctor’s prescription or for preventive purposes.
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** The Drug Directory is intended for informational purposes only. For more complete information, please refer to the manufacturer's instructions. Do not self-medicate; Before starting to use Plaquenil, you should consult a doctor. EUROLAB is not responsible for the consequences caused by the use of information posted on the portal. Any information on the site does not replace medical advice and cannot serve as a guarantee of the positive effect of the drug.
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Plaquenil - contraindications for use
Plaquenil is contraindicated:
- with increased sensitivity to its components in the patient’s body;
- with hereditary intolerance to certain types of simple sugars (for example, with lactase deficiency ) and with malabsorption syndrome (insufficient absorption of one or more nutrients in the intestine);
- for eye diseases associated with retinal changes ( retinopathy );
- children under 6 years old;
- during pregnancy and breastfeeding .
The drug is used with caution when:
- visual impairments, as well as when using medications that have a negative effect on the visual organs;
- blood diseases (including in the past);
- severe neurological diseases and psychoses (including in the past);
- increased skin sensitivity to light, psoriasis and taking medications that increase skin reactions;
- severe diseases of the liver and kidneys and taking medications that negatively affect these organs;
- severe diseases of the digestive system;
- hypersensitivity to quinine (due to the possibility of cross-allergic reactions).
Side effects of Plaquenil
Side effects of Plaquenil are related to the mechanism of its main action.
- From the senses - with long-term use of the drug, changes in the retina (visual field defects - scotomas ), cornea ( blurred vision , photophobia ), as well as disturbances in accommodation (the ability of the eye to clearly see objects located near or far), tinnitus, decreased hearing
- From the nervous system - dizziness , headache , irritable weakness, muscle weakness , gait disturbances, psychosis, convulsive readiness.
- From the circulatory system - a toxic effect on the heart muscle ( myocardium ), accompanied by conduction disturbances ( heart block ) or an increase in the volume of the myocardium of both ventricles.
- On the part of the hematopoietic organs - suppression of the process of formation of blood cells in the bone marrow and the development of a lack of red blood cells (various types of anemia ), leukocytes (the protective properties of the body are reduced) and platelets bleeding appears ).
- From the digestive system - nausea, vomiting, diarrhea, loss of appetite, abdominal pain. With long-term use in large doses, the drug can have a toxic effect on the liver, leading to the development of liver failure .
- Side effects of Plaquenil on the skin and mucous membranes are the most common. These are various kinds of rashes, increased skin sensitivity to light, changes in skin and hair pigmentation, skin itching , baldness , exacerbation of various skin diseases, primarily psoriasis . Severe delayed allergic reactions are possible in the form of Stevens-Johnson syndrome (blisters can cover the entire skin and mucous membranes) and the development of acute generalized exanthematous pustulosis (AGEP) in the form of pustules covering the entire skin.
- Allergic reactions - urticaria , Quincke's edema , bronchospasm .
Plaquenil oral tablets
Instructions for medical use of the drug
Description of pharmacological action
Plaquenil has antimalarial properties and also has anti-inflammatory and immunosuppressive effects in chronic discoid or systemic lupus erythematosus (SLE) and acute and chronic rheumatoid arthritis (RA). The mechanism of its action in malaria, SLE and RA is not fully known. Hydroxychloroquine has the properties of a moderate immunosuppressant, inhibiting the synthesis of rheumatoid factor and components of the acute phase reaction. It also accumulates in leukocytes, stabilizing lysosomal membranes, and inhibits the activity of many enzymes, incl. collagenases and proteases, which cause cartilage breakdown. Efficacy in SLE and RA is associated with the following anti-inflammatory and immunomodulatory effects of hydroxychloroquine: - an increase in intracellular pH leads to a slowdown of the antigenic response and reduces the binding of peptides to the major histocompatibility complex (MHC) receptors. Fewer MHC antigen receptors reach the cell surface, resulting in a decreased autoimmune response; - decreased activity of phospholipase A2 at high concentrations of lysosomal enzymes; - a decrease in the concentrations of IL-1 and IL-6 cytokines, leading to a decrease in clinical and laboratory parameters of the autoimmune response. Since there is no disruption of interferon gamma synthesis, these effects may be due to selective effects on cytokines; — inhibition of pre- and/or post-transcription of DNA and RNA.
Indications for use
- rheumatoid arthritis; - juvenile rheumatoid arthritis; — lupus erythematosus (systemic and discoid); - malaria (except for those caused by chloroquine-resistant strains of Plasmodium falciparum): - for the prevention and treatment of acute attacks of malaria caused by Plasmodium vivax, Plasmodium ovale and Plasmodium malariae, as well as sensitive strains of Plasmodium falciparum; - for the radical treatment of malaria caused by sensitive strains of Plasmodium falciparum.
Release form
Film-coated tablets 200 mg; blister 10 cardboard pack 6;
Pharmacodynamics
The drug actively suppresses asexual erythrocyte forms, as well as gametes of Plasmodium vivax and Plasmodium malariae, which disappear from the blood almost simultaneously with the asexual forms. Plaquenil has no effect on Plasmodium falciparum gametes. Plaquenil is ineffective against chloroquine-resistant strains of Plasmodium falciparum, and is also inactive against extraerythrocytic forms of Plasmodium vivax, Plasmodium malariae and Plasmodium ovale and therefore cannot prevent infection by these microorganisms when prescribed for prophylactic purposes, and also cannot prevent relapse of the disease caused by these pathogens.
Pharmacokinetics
After oral administration, hydroxychloroquine is rapidly and almost completely absorbed. In healthy volunteers, after a single dose of 400 mg, Cmax of hydroxychloroquine in plasma was reached after 1.83 hours and ranged from 53 to 208 ng/ml. Plasma protein binding - 45%. The average T1/2 value from plasma varies depending on the time elapsed after taking the drug as follows: 5.9 hours (from reaching Cmax to 10 hours); 26.1 hours (from 10 to 48 hours) and 299 hours (from 48 to 504 hours). In the liver it is partially converted into active ethylated metabolites. The unchanged drug and its metabolites are well distributed in the body. The volume of distribution is 5–10 l/kg. The drug accumulates in tissues with a high level of metabolism (in the liver, kidneys, lungs, spleen - in these organs the concentration exceeds the plasma concentration by 200–700 times; central nervous system, erythrocytes, leukocytes), as well as in the retina and tissues rich in melanin. Hydroxychloroquine and its metabolites are excreted primarily in the urine and, to a lesser extent, in the bile. The release of the drug is slow, terminal T1/2 is about 50 days (from whole blood) and 32 days (from plasma). Within 24 hours, 3% of the administered dose of the drug is excreted in the urine. Hydroxychloroquine crosses the placental barrier and is found in small quantities in breast milk.
Use during pregnancy
Hydroxychloroquine crosses the placenta. Data are limited regarding its use during pregnancy. It should be noted that 4-aminoquinolines in therapeutic doses can cause intrauterine damage to the central nervous system, incl. auditory nerve (impaired hearing and vestibular apparatus, congenital deafness), hemorrhages in the retina and abnormal pigmentation of the retina. Therefore, the use of hydroxychloroquine during pregnancy should be avoided unless the potential benefit to the mother outweighs the risk to the fetus. You should carefully consider the need to use the drug during breastfeeding, because it has been shown to be excreted in small amounts into mother's milk, and young children are particularly sensitive to the toxic effects of 4-aminoquinolines.
Contraindications for use
- hypersensitivity to 4-aminoquinoline derivatives; - retinopathy; — pregnancy (see “Pregnancy and lactation”); - hereditary lactose intolerance, lactase deficiency, galactosemia or glucose/galactose malabsorption syndrome (due to the presence of lactose in the drug). - children's age when long-term therapy is necessary (children have an increased risk of developing toxic effects); - children under 6 years of age (200 mg tablets are not intended for children with an “ideal” body weight of less than 31 kg). With caution: - visual disorders (decreased visual acuity, impaired color vision, narrowing of visual fields), simultaneous use of drugs that can cause adverse ophthalmological reactions (danger of progression of retinopathy and visual disorders); - hematological diseases (including those with a history); - severe neurological diseases, psychoses (including history); - porphyria cutanea tarda (risk of exacerbation), psoriasis (risk of increased skin manifestations of the disease), simultaneous use of drugs that can cause skin reactions; - renal failure and/or liver failure, hepatitis, concomitant use of drugs that can adversely affect liver and/or kidney function (in case of severe impairment of renal or liver function, the dose should be selected under the control of plasma concentrations of hydroxychloroquine); - deficiency of glucose-6-phosphate dehydrogenase; - severe gastrointestinal diseases; - hypersensitivity to quinine (possibility of cross-allergic reactions).
Side effects
On the part of the organ of vision: retinopathy with changes in pigmentation and defects in the visual fields can develop, although rarely. In the early form, these effects are usually reversible when hydroxychloroquine is stopped. If the condition remains undiagnosed and retinal lesions continue to develop further, there may be a risk of their progression even after discontinuation of the drug. Retinal changes may initially be asymptomatic, or manifest as paracentral or pericentral scotomas, transient scotomas, and color vision impairment. Corneal changes may occur, including swelling and clouding. They may be asymptomatic or cause visual disturbances such as halos, blurred vision, or photophobia. When treatment is stopped, these changes may reverse. Visual disturbances associated with accommodation disturbances may also occur, which are dose-dependent and reversible. From the skin: sometimes there are skin rashes; Itching, changes in pigmentation of the skin and mucous membranes, hair discoloration and alopecia are also described. These changes usually resolve quickly after treatment is stopped. Bullous rashes have been reported, including very rare cases of erythema multiforme and Stevens-Johnson syndrome, photosensitivity and isolated cases of exfoliative dermatitis. Very rare cases of acute generalized exanthematous pustulosis (AGEP) must be distinguished from psoriasis, although hydroxychloroquine can also provoke an exacerbation of psoriasis. OHEP may be accompanied by fever and hyperleukocytosis. After discontinuation of the drug, the outcome is usually favorable. From the gastrointestinal tract: nausea, diarrhea, anorexia, abdominal pain and rarely vomiting. These symptoms usually disappear immediately after the dose is reduced or the drug is discontinued. From the hepatobiliary system: with long-term use in large doses, hepatotoxic effects may develop. There are reports of isolated cases of liver dysfunction and several cases of sudden onset liver failure. From the side of the central nervous system: infrequently - dizziness, tinnitus, hearing loss, headache, irritability, emotional instability, psychosis, convulsions, muscle weakness, ataxia. From the peripheral nervous system and muscles: cases of skeletal muscle myopathy or neuromyopathy have been reported, leading to progressive weakness and atrophy of proximal muscle groups. Myopathy may be reversible after discontinuation of the drug, but full recovery may take several months. At the same time, mild sensory changes, suppressed tendon reflexes, and decreased nerve conduction may occur. From the cardiovascular system: there are rare reports of the development of cardiomyopathy. Chronic cardiac toxicity may be suspected when conduction abnormalities (bundle branch block/AV conduction disturbances) or biventricular hypertrophy are detected. If the drug is discontinued, these changes may reverse. From the hematopoietic organs: cases of suppression of bone marrow hematopoiesis have been rarely reported. Rare cases of anemia have been reported, incl. aplastic, agranulocytosis, leukopenia and thrombocytopenia. Hydroxychloroquine may precipitate or worsen porphyria. From the immune system: urticaria, angioedema, bronchospasm.
Directions for use and doses
Note: All doses are for hydroxychloroquine sulfate and are not equivalent to doses for the base. Inside, during meals or with a glass of milk. Treatment of RA. Hydroxychloroquine has cumulative activity. It takes several weeks of taking the drug for its therapeutic effect to manifest itself, while side effects may appear relatively early. The necessary therapeutic effect develops after several months of taking the drug. If there is no objective improvement in the patient's condition within 6 months of taking hydroxychloroquine, the drug should be discontinued. Adults (including older adults) should take the minimum effective dose. They should not exceed 6.5 mg/kg/day (calculated based on “ideal” body weight, not actual body weight) and can be either 200 or 400 mg/day. In patients able to take 400 mg daily Initially, 400 mg daily in divided doses. When obvious improvement is achieved, the dose can be reduced to 200 mg. If the effect decreases, the maintenance dose can be increased to 400 mg. For children. The minimum effective dose should be used. The dose should not exceed 6.5 mg/kg (based on “ideal” body weight). Therefore, the 200 mg tablets are not suitable for children with an “ideal” body weight of less than 31 kg. Use of the drug Plaquenil for combination therapy of RA. Plaquenil can be safely used in combination with corticosteroids, salicylates, NSAIDs, methotrexate and other second-line therapeutic agents. After several weeks of using the drug Plaquenil, the doses of corticosteroids and salicylates may be reduced or these drugs may be discontinued. Doses of GCS should be reduced gradually every 4-5 days: the dose of cortisone - by no more than 5-15 mg, the dose of hydrocortisone - by no more than 5-10 mg, the dose of prednisolone and prednisone - by no more than 1-2.5 mg , the dose of methylprednisolone and triamcinolone - no more than 1-2 mg and dexamethasone - no more than 0.25-0.5 mg. Treatment of SLE. The initial average dose in adults is 400 mg 1 or 2 times a day. It should be given over several weeks or months depending on the patient's response. For long-term maintenance therapy, it is sufficient to use the drug in a lower dose - from 200 to 400 mg. Treatment of malaria Prevention of acute attacks of malaria caused by P. malariae and susceptible strains of Plasmodium falciparum Adults - 400 mg weekly on the same day of the week. For children, the weekly dose is 6.5 mg/kg (for calculation, the “ideal” body weight is taken), however, regardless of body weight, it should not exceed the dose for adults. If conditions allow, preventive therapy should begin 2 weeks before entering an endemic area. If this is not possible, then an initial double (loading) dose can be prescribed: adults - 800 mg, children - 12.9 mg/kg of “ideal” body weight (but not more than 800 mg), divided into two doses with a 6-hour interval. Preventive treatment should be continued for 8 weeks after leaving the endemic area. Treatment of acute attacks of malaria For adults, an initial dose of 800 mg is followed by a dose of 400 mg after 6 or 8 hours, and then 400 mg on 2 subsequent days (for a total of 2 g of hydroxychloroquine sulfate). Alternative treatment: A single dose of 800 mg has also been shown to be effective. Doses for adults can also be calculated based on “ideal” body weight, similar to the calculation of doses for children (see below). For children, a total dose of 32 mg/kg of “ideal” body weight (but not higher than 2 g) is prescribed for 3 days as follows: first dose - 12.9 mg/kg (single dose not more than 800 mg); second dose - 6.5 mg/kg (not more than 400 mg) 6 hours after the first; third dose - 6.5 mg/kg (not more than 400 mg) 18 hours after the second dose; fourth dose - 6.5 mg/kg (not more than 400 mg) 24 hours after the third dose. Radical treatment of malaria caused by Plasmodium malariae and Plasmodium vivax For radical treatment of malaria caused by Plasmodium malariae and Plasmodium vivax, simultaneous administration of 8-aminoquinolone derivatives is necessary.
Overdose
An overdose of 4-aminoquinolines is especially dangerous in children; even 1–2 g of the drug can be fatal. Symptoms: headache, visual disturbances, collapse, convulsions, hypokalemia, rhythm and conduction disturbances, followed by cardiac and respiratory arrest. Treatment: because These effects can develop very quickly after taking a large dose of the drug; in these cases, appropriate measures should be started immediately. Induction of vomiting or gastric lavage through a tube should be performed immediately. To slow down absorption, prescribe activated carbon in a dose at least 5 times higher than the dose of the drug taken. Parenteral administration of diazepam is advisable (a decrease in the cardiotoxicity of chloroquine against its background has been described). If necessary, artificial ventilation and antishock therapy should be performed. After relief of overdose symptoms, continued medical supervision is required for at least 6 hours.
Interactions with other drugs
Digoxin. It has been reported that hydroxychloroquine is capable of increasing plasma concentrations of digoxin; therefore, in order to avoid the development of glycoside toxicity when taking these drugs simultaneously, it is necessary to reduce the dose of digoxin while monitoring its plasma concentrations. Medicines used to treat diabetes mellitus. Because hydroxychloroquine may potentiate the effects of insulin and oral hypoglycemic agents, it may be necessary to reduce the dosage of these antidiabetic agents when initiating hydroxychloroquine. Antacids. May reduce the absorption of hydroxychloroquine. Therefore, when using antacids and hydroxychloroquine simultaneously, the interval between their administration should be at least 4 hours. With hydroxychloroquine, the following interactions with other drugs that have been described for chloroquine, but have not yet been observed when taking hydroxychloroquine, cannot be excluded. Aminoglycosides. Potentiation of their direct blocking effect on neuromuscular transmission. Cimetidine. Suppresses the metabolism of antimalarial drugs, which can lead to an increase in their plasma concentrations and increase the risk of developing their side effects, especially toxic ones. Neostigmine and pyridostigmine. Antagonism of action. Any intradermal human diploid cell rabies vaccine. Decreased antibody production in response to primary immunization with intradermal human diploid cell rabies vaccine.
Special instructions for use
General Retinal toxicity is largely dose dependent. The incidence of retinopathy at doses up to 6.5 mg/kg of “ideal” body weight is low. Exceeding the recommended daily dose sharply increases the risk of developing retinopathy and accelerates its onset. Before starting a long course of treatment with the drug, a thorough examination of both eyes should be performed. The examination should include determination of visual acuity, examination of the fundus, assessment of color vision and visual fields. During therapy, such examination should be carried out at least once every 6 months. Examination should be more frequent in the following situations: - with a daily dose exceeding 6.5 mg/kg of “ideal” body weight (in obese patients, using absolute body weight to calculate the dose may lead to an overdose); - in case of renal failure; - with a total dose of over 200 g; - in elderly people; - with reduced visual acuity. If any visual disturbances occur (decreased visual acuity, changes in color vision), the drug should be discontinued immediately and the patient’s visual condition should be carefully monitored, because Retinal changes (and visual disturbances) may progress even after drug discontinuation. It is recommended to exercise caution when prescribing hydroxychloroquine to patients with liver and kidney diseases, who may require a dose reduction of the drug, as well as due to the possibility of the drug affecting the function of these organs (in case of severe impairment of kidney or liver function, the dose should be selected under the control of plasma concentrations of hydroxychloroquine) . In patients receiving long-term treatment, a complete blood count should be performed periodically; if hematological disorders occur, hydroxychloroquine should be discontinued. Children are particularly sensitive to the toxic effects of 4-aminoquinolines, so care should be taken to keep hydroxychloroquine out of the reach of children. All patients receiving the drug for a long time should be periodically examined by a neurologist regarding the functions of skeletal muscles and the severity of tendon reflexes. If muscle weakness occurs, the drug should be discontinued. In malaria, Plaquenil is ineffective against chloroquine-resistant strains of Plasmodium falciparum, and is also inactive against extra-erythrocytic forms of Plasmodium vivax, Plasmodium malariae and Plasmodium ovale and therefore cannot prevent infection by these microorganisms when prescribed to prevent acute attacks of malaria, and also cannot prevent relapse of the disease caused by these pathogens. Impact on the ability to drive a car and perform work associated with increased danger. Patients should be careful when driving or performing work that requires increased attention, because Hydroxychloroquine may impair accommodation and clarity of vision. If this condition does not go away on its own, the dose may be temporarily reduced.
Storage conditions
List B.: At a temperature not exceeding 25 °C.
Best before date
36 months
ATX classification:
P Antiparasitic drugs, insecticides and repellents
P01 Antiprotozoal drugs
P01B Drugs for the treatment of malaria
P01BA Aminoquinolines
P01BA02 Hydroxychloroquine
Instructions for Plaquenil
The instructions for use of Plaquenil provide for its use only as prescribed by a doctor. Plaquenil tablets are taken orally, with meals or with a glass of milk.
In the treatment of rheumatoid arthritis and systemic lupus erythematosus, the therapeutic effect of using Plaquenil develops after several weeks or even months (the drug gradually accumulates in the body), while side effects can appear much earlier. Therefore, the doctor must decide whether to continue treatment with this drug and in what dosage. In any case, the doctor selects an individual effective dosage of the drug (it is 6.5 mg per kg of body weight or 1 - 2 tablets per day). If the therapeutic effect cannot be achieved within six months, then Plaquenil is discontinued.
To prevent malaria, the drug should be taken two weeks before leaving for an area where this disease occurs. It is taken once a week on the same day, 2 tablets (400 mg) during the entire stay in the endemic zone and for another two months after leaving it.
To treat acute attacks of malaria, first take 4 tablets of Plaquenil (800 mg), after 8 hours - 2 tablets (400 mg) and in the next 2 days - 2 tablets (400 mg).
To completely cure tropical malaria (if the pathogen is sensitive to the drug), taking Plaquenil is combined with taking medications belonging to the group of 8-aminoquinoline ( Plasmocide , Plasmoquine , Quinocidum , Primaquine ).
special instructions
Plaquenil is not effective against extraerythrocyte forms of Plasmodium malariae, Plasmodium ovale, Plasmodium vivax and chloroquine-resistant strains of Plasmodium falciparum, therefore, when used to prevent acute attacks of malaria, it will not prevent infection with these pathogens, nor will it be able to prevent relapse of the disease caused by these microorganisms .
The retinal toxicity of hydroxychloroquine is largely dose dependent. The incidence of retinopathy when taking the drug in doses less than 6.5 mg/kg is small. If the recommended daily dose is exceeded, the likelihood of developing retinopathy greatly increases.
If long-term treatment is necessary, before prescribing Plaquenil, the patient is sent for a thorough examination of both eyes: determination of visual acuity and color perception, assessment of visual fields, examination of the fundus. Periodically - at least once every six months - this examination should be repeated. In the following cases, more frequent examination is necessary:
- The daily dose exceeds 6.5 mg/kg of ideal body weight;
- The total dose exceeds 200,000 mg;
- Initially reduced visual acuity;
- Kidney failure;
- Old age of the patient.
Patients should be warned about the need to immediately discontinue the drug and consult a doctor for examination if any visual disturbances occur (for example, changes in color vision or decreased visual acuity), since progression of visual disturbances and retinal changes is possible even after stopping treatment with Plaquenil.
During long-term treatment, it is also necessary to regularly perform a complete blood count. Hydroxychloroquine should be discontinued if hematological abnormalities occur.
All patients receiving Plaquenil for a long time should be periodically examined by a neurologist regarding the severity of the tendon reflex and skeletal muscle function. If muscle weakness is observed, treatment should be discontinued.
Patients with impaired renal and liver function may require a dose reduction.
Hydroxychloroquine can impair accommodation and thereby reduce the clarity of visual perception, therefore, during the period of therapy, care should be taken when driving vehicles and performing types of work that require speed of reactions and increased attention.
Interaction of Plaquenil with other drugs
Plaquenil can be combined with glucocorticosteroids (GCS), for example Prednisolone , non-steroidal anti-inflammatory drugs (NSAIDs), for example Diclofenac , Ibuprofen , Methotrexate .
Plaquenil enhances (potentiates) the effect of: the cardiac glycoside Digoxin , Insulin and other drugs for the treatment of diabetes, antibiotics from the aminoglycoside ( Neomycin , Gentamicin ).
When taking an H2-antihistamine to reduce the acidity of gastric juice, Cimetidine, the decomposition process of Plaquenil in the liver is suppressed and its concentration in the blood plasma increases. This increases the risk of side effects and overdose.
Antacids - drugs that neutralize the effect of hydrochloric acid in the stomach (for example, Almagel ) help reduce the absorption of Plaquenil. To prevent this from happening, it is recommended to maintain intervals between doses of these drugs of at least 4 hours.
Plaquenil reduces the effectiveness of Proserin, as it is its antagonist.
When using Plaquenil, there is a decrease in the formation of antibodies in response to the administration of human diploid cell rabies .
Analogues of Plaquenil
Level 4 ATX code matches:
Immard
Delagil
Analogues are drugs from different drug groups that are used to treat the same diseases. Analogues of Plaquenil are:
- Delagil is a 6-aminoquinoline and has the same indications for use as Plaquenil;
- Medicines belonging to the group of 8-aminoquinoline with antimalarial action: Plazmocid , Plazmokhin , Khinocid , Primaquin .
Reviews of Plaquenil
Reviews of Plaquenil mainly depend on the correctness of its purpose. In addition, this drug is not suitable for everyone; in some patients it immediately causes side effects.
Reviews about Plaquenil on the forums are mostly positive. Patients who have taken it for long courses for systemic connective tissue diseases note that side effects are very rare, the drug combines well with other anti-inflammatory and analgesic drugs and helps reduce their dosage.
Negative reviews of Plaquenil are due to the drug's side effects, which are rare but can be significant.
Analogs
"Immard"
Ipka Laboratories Limited (India) Price from 350 to 468 rubles.
An antimalarial drug that also has anti-inflammatory and immunosuppressive effects. Available in tablet form containing 200 mg of hydroxychloroquine.
pros
- Low cost
- Guaranteed cure for malaria.
Minuses
- Common gastrointestinal side effects
- Poorly tolerated by older people.
"Delagil"
ICN Polfa Rzeszow AO, Poland Price from 175 to 291 rubles.
A universal drug of a new generation, acting as an antidepressant, anti-inflammatory and antiprozoal agent. Each tablet contains 250 mg of chloroquine.
pros
- Cures photodermatosis (allergy to sun rays) and amoebiasis
- Long shelf life - 5 years.
Minuses
- Long-term use causes vision problems
- It is necessary to monitor your health status from several specialists.
Plaquenil price
The price of Plaquenil in Moscow pharmacies ranges from 500 to 600 rubles per package (60 tablets).
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
LuxPharma* special offer
- Plaquenil tab.
200 mg No. 60 RUB 3,000 order
Pharmacy Dialogue
- Plaquenil (tab.p.pl/vol. 200 mg No. 60)Sanofi Aventis
RUR 575 order
show more
Pharmacy24
- Plaquenil 200 mg No. 60 tablets Sanofi Aventis SA, Spain
548 UAH.order
Release form and composition
Dosage form – film-coated tablets: round, biconvex, white, engraved “HCQ” on one side, “200” on the other (10 pcs in blisters, 6 blisters are packed in a cardboard pack).
Active substance: hydroxychloroquine sulfate – 200 mg in 1 tablet.
Auxiliary components: magnesium stearate, povidone K25, corn starch, lactose monohydrate, opadry OY-L-28900 (titanium dioxide, macrogol 4000, hypromellose, lactose monohydrate).
