Contraindications

As outlined previously, the severity of the treated disease has to be weighed against the risk of its therapy. Chloroquine and hydroxychloroquine are contraindicated in the case of hyperreactivity to 4-aminoquinolones (exanthema or exfoliative dermatitis), retinopathy or impaired visual fields (danger of blindness), disorders of the hematopoietic system (risk of anemia, leukopenia, or agranulocytosis), glucoses-phosphate dehydrogenase deficiency (danger of hemolysis; see previously), myasthenia gravis (neuromyopathy), and pregnancy (risk of malformations [exception: malaria and nursing; see previously]).

In the case of a history of porphyria, seizures (in individual cases, exacerbation of seizures), and severe liver or kidney insufficiency (risk of additional kidney damage and impaired chloroquine excretion), limiting chloroquine use is recommended. This also holds true for psoriasis, although in larger patient series no general deterioration of this skin disease was described (see Ochsendorf and Runne 1991).

Table 26.2. Drug interactions of chloroquine and hydroxychloroquine

Combination of chloroquine

andhydroxychloroquine with ...

Has no effect Decreases bioavail-

Bioavailability of

Increases rate of

ability of

chloroquine is

decreased by

Acetylsalicylic acid Ampicillin Cholestyramine Cutaneous reactions

Ranitidine Bacampicillin Caolin/pectin Phenylbutanoze

Imipramine Ammonium chloride Pyrimethamin/sulfa-

Acetylsalicylic acid Ampicillin Cholestyramine Cutaneous reactions

Ranitidine Bacampicillin Caolin/pectin Phenylbutanoze

Imipramine Ammonium chloride Pyrimethamin/sulfa-

doxin

Sensibilization: Probenecid Muscle weakness: Glucocorticoids Aminoglycosides

Increases side effects of

Increases plasma levels of

Bioavailability of chloroquine is increased by

Decreases effects of

Aurothioglucose

Digoxin

Cimetidine

Physostigmine

Penicillamine

Methotrexate

Ritonavir

Neostigmine

Cyclosporine

Quinacrine

Rabies vaccination

Typhus vaccination

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