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HYDROXYCHLOROQUINE (PLAQUENIL) CARDIOTOXICITY:
AN UNCOMMON COMPLICATION OF A COMMON MEDICATION
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Case
A 65 year old man presented with acute decompensated HF. He had a history of rheumatoid arthritis, and had been treated with hydroxychloroquine for the last 8 years. Echocardiography revealed a left ventricular ejection fraction of 25%, with diffuse hypokinesis. Coronary angiography demonstrated non-obstructive coronary disease. Treatment was initiated with guideline directed medical therapy, and patient clinically improved.
HYDROXYCHLOROQUINE (PLAQUENIL) CARDIOTOXICITY: AN UNCOMMON COMPLICATION OF A COMMON MEDICATION
Hydroxychloroquine (HCQ)-induced cardiomyopathy is one of the rare but severe complications following prolonged HCQ use. However, the exact mechanism of HCQ cardiotoxicity remains unclear and it is difficult to identify risk factors. We present a case of twin sisters who both suffered from systemic lupus erythematosus (SLE) and HCQ-induced cardiomyopathy presenting with decompensated heart failure (HF), suggesting that genetic predisposition might be a factor in HCQ-induced cardiomyopathy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863196/
Hydroxychloroquine (HCQ) is one of the antimalarial drugs that have been used for decades to treat rheumatic diseases (1). Retinal toxicity, neuromyopathy, and cardiac toxicity are recognized toxicities following prolonged use (1). HCQ-induced cardiomyopathy is one of the rare but severe complications which could be reversible with early withdrawal of the drug (2). However, the exact mechanism of HCQ cardiotoxicity remains unclear (1) and the role of heredity has not been studied due to the rare occurrence of the disease. We present a case of twin sisters who both suffered from systemic lupus erythematosus (SLE) and HCQ-induced cardiomyopathy presenting with decompensated heart failure (HF)
https://acrabstracts.org/abstract/increased-risk-of-heart-failure-with-prolonged-use-of-hydroxychloroquine-in-patients-with-rheumatoid-arthritis/
Are there any reasons I won't be prescribed hydroxychloroquine?
Before starting on hydroxychloroquine your doctor may take a blood test to check that your liver and kidneys are working normally, but you won't need any regular blood tests during the treatment.
Your doctor will ask you about any problems with your eyesight and may suggest you have a vision test. Hydroxychloroquine won't usually be prescribed if you have maculopathy, problems with the central part of the retina in the eye.
https://www.versusarthritis.org/about-arthritis/treatments/drugs/hydroxychloroquine/
Side effects and risks
Side effects aren't common. However, in some people hydroxychloroquine can cause:
• skin rashes, especially those made worse by sunlight
• feeling sick (nausea) or indigestion
• diarrhoea
• headaches
• bleaching of the hair or mild hair loss
• tinnitus (ringing in the ears)
• visual problems.
There's a small risk that hydroxychloroquine can damage a part of the inside of the eye called the retina. And this increases with long-term use and higher dosage.
Your doctor will advise you on a safe dose to take according to your weight, and you will need to have regular monitoring of your eyes.
This monitoring of your eyes may be arranged at a hospital clinic when you start the drug and then again once a year in a hospital when you have been taking the drug for more than five years.
Otherwise, you should have a check up with an optician once a year and tell them that you're taking hydroxychloroquine.
You should report any new eye symptoms to your doctor straight away.
If you develop any other new symptoms or there's anything else that concerns you after starting hydroxychloroquine, you should tell your doctor or rheumatology nurse specialist as soon as possible.
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