How toxic is an old friend? A review of the safety of hydroxychloroquine in clinical practice.

Jessica L Fairley, Mandana Nikpour, Heather G Mack, Maria Brosnan, Amanda M Saracino, Marc Pellegrini, Ian P Wicks

Journal: Internal medicine journal 2023;53(3):311-317

PMID: 35969110

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Abstract

Hydroxychloroquine (HCQ) and its close relative chloroquine (CQ) were initially used as antimalarial agents but are now widely prescribed in rheumatology, dermatology and immunology for the management of autoimmune diseases. HCQ is considered to have a better long-term safety profile than CQ and is therefore more commonly used. HCQ has a key role in the treatment of connective tissue diseases including systemic lupus erythematosus (SLE), where it provides beneficial immunomodulation without clinically significant immunosuppression. HCQ can also assist in managing inflammatory arthritis, including rheumatoid arthritis (RA). Debate around toxicity of HCQ in COVID-19 has challenged those who regularly prescribe HCQ to discuss its potential toxicities. Accordingly, we have reviewed the adverse effect profile of HCQ to provide guidance about this therapeutic agent in clinical practice.

Address: Department of Rheumatology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.; Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), Melbourne, Victoria, Australia.; Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.; Department of Ophthalmology, Melbourne Health, Melbourne, Victoria, Australia.; Department of Cardiology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.; Department of Medicine, Monash University, Melbourne, Victoria, Australia.; Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.; Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia.

DOI: 10.1111/imj.15908

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MeSH Terms: Humans, Hydroxychloroquine, Antirheumatic Agents, Friends, COVID-19, COVID-19 Drug Treatment, Chloroquine, Lupus Erythematosus, Systemic