Adverse Effects

Skin rashes and pruritus are common adverse effects of the 4-aminoquinoline antimalarials, as are GI effects. The incidence of the most serious toxic reaction, irreversible retinopathy with resultant blindness, is dose related and can be minimized by maintaining a daily dose of hydroxychloroquine less than 6.5 mg/kg or chloroquine less than 4 mg/kg. Eye examinations should be performed regularly during treatment with these drugs. Severe hematological toxicity (neutropenia, thrombo-cytopenia, aplastic anemia) is rare. Reversible side effects observed during high-dose, long-term therapy with the aminoquinolines include lichenoid skin lesions, leukopenia, neuromyopathy, hair loss, sensitivity to sunburn, and changes in the electrocardiogram.

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