Toxicology and Side Effects Acute Overdose

Acute overdosing happens accidentally, mainly in children, or during an attempted suicide. Even a single dose of 750 mg of chloroquine (only three pills) can be lethal in small children (1-4 years old). Doses between 1 g (children) and 4 g (adults) may lead to cardiac arrhythmias, cardiac arrest, and death. Therefore, patients have to be explicitly informed about the absolute necessity of safe storage of these drugs to protect their children. In case of misuse, vomiting should be triggered immediately.

Owing to the accumulation in deep compartments and the inability to remove chloroquine, the treatment of acute chloroquine poisoning is very difficult. A better prognosis was reported with the following regimen: gastric lavage followed by active coal char for prevention of further absorption, early assisted ventilation, diazepam

Fig. 26.1A-D. Clinical examples of correct doses. Only one patient (D) of this series would not be overdosed with a standard application of 250 mg of chloroquine. A The dose of the (index) person on the left has to be calculated according to her actual weight, which is lower than her ideal weight. Although the person on the right is taller and heavier, he still needs less than 250 mg chloroquine per day

Fig. 26.1A-D. Clinical examples of correct doses. Only one patient (D) of this series would not be overdosed with a standard application of 250 mg of chloroquine. A The dose of the (index) person on the left has to be calculated according to her actual weight, which is lower than her ideal weight. Although the person on the right is taller and heavier, he still needs less than 250 mg chloroquine per day

Height (cm)

Weight (kg)

Ideal body weight (kg)

Daily chloroquine dose (mg)

Daily hydroxychloroquine dose (mg)

Left

160 48 51

Right

165 71 59

B The male is smaller than the index person and weighs much more but nevertheless needs about the same daily dose.

Left Right

Height (cm) 160 155

Weight (kg) 48 80

Ideal body weight (kg) 51 50

Daily chloroquine dose (mg) 168 175

Daily hydroxychloroquine dose (mg) 288 (max. 312) 300 (max. 325)

Fig. 26.1A-D. Clinical examples of correct doses. Only one patient (D) of this series would not be overdosed with a standard application of 250 mg of chloroquine (continued). C Although the lady on the right weighs three times more than the index person, the daily dose is about the same.

Left Right

Height (cm) 160 159

Weight (kg) 48 150

Ideal body weight (kg) 51 50

Daily chloroquine dose (mg) 168 175

Daily hydroxychloroquine dose (mg) 288 (max. 312) 300 (max. 325)

D The daily dose of one tablet (250mg/day of chloroquine) for the man would be no problem and could eventually be increased.

Left

Right

Height (cm)

196

160

Weight (kg)

125

48

Ideal body weight (kg)

86

51

Daily chloroquine dose (mg)

250 (up to 344)

168

Daily hydroxychloroquine dose (mg)

400 (up to 516, max. 559)

288 (max. 312)

Table 26.5. Recommendations for the practical management of the maximal daily dose of hydroxychloroquine (6-6.5 mg/kg ideal body weight). Using 200-mg tablets3

a Caution is necessary in patients with hepatic or renal disease, in whom a dose reduction may be necessary (modified after Canadian rheumatology association 2000).

administration, monitoring of potassium levels and replacement, and, in case of shock, epinephrine administration (Clemessy et al. 1996). The symptoms, clinical course, and treatment of hydroxychloroquine intoxication are the same as those of chloroquine intoxication (Jordan et al. 1999, Marquardt and Albertson 2001).

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