"Plaquenil": instructions for use. Description of the drug, analogues
Treatment of malaria, lupus erythematosus, rheumatoid arthritis is possible with antiprotozoal drugs based on hydroxychloroquine, which can suppress the causative agents of diseases. The drug "Plaquenil" from this group allows to reduce the symptoms of inflammation, disrupts the development of Plasmodium malaria in erythrocyte cells, which improves the patient's condition.
Being a 4-aminoquinoline derivative, the drug has anti-malarial and amebicidal action, exhibits the properties of immunosuppressants.
The drug "Plaquenil" describes the instructions for use as a tablet drug, the active component of which is hydroxychloroquine sulfate at a dosage of 200 mg. The tablets have a round, biconvex shape, covered with a white film on top, “HCQ” engraving is applied on one side,on the other hand, there is an indication of the dose “200”.
What treats the drug?
"Plaquenil" is a medicine that is taken with:
- rheumatoid arthritis;
- juvenile rheumatoid arthritis;
- systemic lupus erythematosus;
- lupus erythematosus of discoid character;
- malaria (except forms with chloro-resistant strains of Plasmodium falciparum).
The drug is used for prophylactic and therapeutic purposes, when there is a threat of acute attacks of malaria. Plasmodium vivax, Plasmodium oval, Plasmodium malaria and sensitive strains of Plasmodium falciparum can be the causative agents of this disease.
Opinion of patients and doctors about the drug
About applicationof the drug “Plaquenil”, the reviews of doctors are mostly positive, they indicate the occurrence of persistent remission during the treatment of systemic lupus erythematosus and a milder effect compared to “Azathioprine”. The drug is long-term, but subject to the absence of adverse reactions.
Often there is a weakening of vision from taking tablets "Plaquenil". Reviews of patients indicate the development of seizures, headache, tinnitus, numbness of the face of the head, stomach pain and skin rashes.Any side effects require consultation with a doctor and the possible discontinuation of the drug.
In the treatment of rheumatoid arthritis, the drug "Plaquenil" is effective, patient reviews indicate a marked relief of the condition and a reduction in inflammation of the joints. Usually rheumatologists prescribe it in combination with hormone therapy, for example, taking the hormone prednisone. With such therapy, rarely adverse reactions from the drug "Plaquenil". Reviews of patients who did not help the tool, rarely accompanied by statements about the deterioration of the body.
The action of hydroxychloroquine during the treatment of malaria, systemic lupus erythematosus and rheumatoid arthritis is not fully understood, but it is known that its immunosuppressive role is to inhibit the synthesis of rheumatism factor and other components of this process. The lysosomal membranes stabilize due to the accumulation of the drug in leukocyte cells, the destruction of cartilage tissue is reduced due to the suppression of the activity of enzymes such as collagenase and protease.
The anti-inflammatory and immunomodulatory effects of hydroxychloroquine in the treatment of rheumatoid arthritis and lupus erythematosus are associated with several factors:
- An increase in the pH of the cell, which slows down the antigenic response and leads to a decrease in the binding of the receptor peptides included in the complex for compatibility with histamine. This limits the number of receptors reaching the cell surface and reduces the autoimmune response.
- Reduced activity of a high concentration of A2-phospholipase and enzymes in the lysosome.
- A decrease in the number of interleukin-1 and interleukin-6, leading to an underestimation of the results of clinical and laboratory diagnostics indicators in the autoimmune response.
- Reduced pretranscription and processing of RNA and DNA molecules.
Antimalarial medicines are used to treat and prevent an infectious disease, malaria, which is characterized by fever, anemia, an enlarged liver and spleen. The causative agent of the infection is malarial plasmodium, which is transmitted by a female mosquito of the genus Anopheles.
The action of the drug is aimed at suppressing asexual erythrocyte forms (merozoites) and germ cells of the strains Plasmodium vivax and Plasmodium malaria, which can simultaneously disappear from the erythrocytes of blood.Do not affect the germ cells Plasmodium falciparum tablets "Plaquenil". Instructions for use indicate their ineffectiveness with respect to chloroquine-resistant strains of Plasmodium falciparum and non-erythrocyte forms of Plasmodium vivac, Plasmodium malaria and Plasmodium oval. The use of the drug for prophylaxis is not able to save a person from these microorganisms and subsequent reinfection of the organism.
The instructions describe in detail how to take "Plaquenil" in the treatment of each of the diseases. Tablets are intended for ingestion during the use of food, 250 ml of milk can be drunk.
The dosage of the drug is aligned with the hydroxychloroquine sulfate salt and is not equivalent to the dose of the base.
The drug Plaquenil for rheumatoid arthritis begins to act only after 14 days. Instructions for use include data on the cumulative effect of hydroxychloroquine, but unwanted reactions from various organs may appear much earlier than the positive dynamics. The emergence of a therapeutic effect is possible after several months of drug treatment, in the case of their absence, after six months, taking this medication is stopped.
For adults and elderly people use the minimum effective dose that does not exceed 6.5 mg per 1 kg of the ideal weight of a person, which is equal to 200 mg per day or 400 mg.
If the initial daily dose of 400 mg is taken, it is divided into 2-3 doses. With the appearance of a noticeable result in the treatment, the dosage is halved. If after this a decrease in the effect is observed, they return again to a dose of 400 mg.
For children, use a minimum dose not exceeding 6.5 mg per 1 kg of ideal weight. The drug "Plaquenil" (200 mg tablets) is not used in children whose body weight is below 31 kg.
Usually used complex treatment of rheumatoid arthritis in combination with glucocorticosteroids, nonsteroidal anti-inflammatory drugs, salicylic acid salts.
After 14 days from the start of combination therapy, the dose of glucocorticosteroids and salicylates is reduced or completely canceled. The reduction is carried out in stages, every 5 days. For each glucocorticosteroid in the instructions there are recommendations for reducing dosing.
Systemic lupus erythematosus in adults is treated for the first few weeks or during the month with a daily dosage of 400 mg in 1 or 2 doses.Further supportive therapy is the use of a lower dose of the drug in 200 or 400 mg.
For radical treatment of malaria, the causative agents of which are Plasmodium vivac and Plasmodium malaria, combine the drug Plaquenil with derivatives of 8-aminoquinolone to enhance the effect of hydroxychloroquine.
To prevent adults in acute malaria, which is caused by the Plasmodium malaria causative agent and chloroquine-resistant strains of Plasmodium falciparum, a dosage of 400 mg is used once a week, every 7 days. The pediatric dose for weekly use will be 6.5 mg per 1 kg of ideal weight, but not more than the adult dose.
It is advisable before entering the zone of possible infection for 14 days to conduct prophylactic administration of the drug. If the course of the Plaquenil pills was not soaked, a double dose is prescribed: 800 mg each - for adults, 12.9 mg per 1 kg of ideal weight for children, but not more than an adult dose (divided intake twice at intervals of 6 hours between them).
For the treatment of the acute state of malaria in adults, a dosage of 800 mg is prescribed, after a period of time from 6 to 8 hours, another 400 mg are drunk. The next two days take 400 mg of hydroxychloroquine sulfate.
Another effective treatment may be a single dose at 800 mg.
For children, a special regimen for treating an acute condition with a dosage of 32 mg per 1 kg of weight is provided, but it should not exceed the total dose for adults. This therapy is designed for 3 days and is divided into 4 doses:
- at the first dose they take 12.9 mg per 1 kg of weight, but not more than 800 mg;
- after 6 hours, take a second dose of 6.5 mg per 1 kg of weight, but not more than 400 mg;
- after 18 hours, drink another dose of 6.5 mg per 1 kg of weight, not more than 400 mg;
- one day, drink the last dose of 6.5 mg per 1 kg of weight, not more than 400 mg.
Some patients develop side effects from Plakenil, which affect various body systems.
The organs of vision are most affected. One of the undesirable consequences is retinopathy, when the retina of the eyeball is affected due to a disturbed blood supply. Pigment changes and defects in the visual field occur. In the early stages, the state of retinopathy is reversible, this is achieved by discontinuing hydroxychloroquinone. Further use of the drug leads to irreversible damage to the retina.Retinopathy may begin asymptomatically or with the appearance of paracentral, pericentral or transient scotoma, impairment of ability to perceive and differentiate color.
Changes may affect the cornea, which is reflected in its swelling and clouding. Proceeds asymptomatically or with the appearance of a halo, indistinct vision or pathological sensitivity of the body to the effects of light. Discontinuation of the drug leads to the disappearance of these symptoms.
A side effect may be a violation of a clear perception of objects removed at different distances. With the abolition of the drug vision is restored.
Undesirable effects of taking Plaquenil tablets are described as dermatological reactions, characterized by skin rashes, itching, changes in skin pigment and mucous membranes, discoloration and hair loss. Discontinuation of the drug leads to the disappearance of symptoms.
There have been cases of bullous rash, multiforme or malignant exudative erythema, photosensitivity and exfoliative dermatitis.
In rare cases, there is acute generalized exantmatouspustus, characterized by elevated temperature and an increase in the number of leukocytes in the blood, can be exacerbated by psoriasis. Discontinuation of the drug leads to the disappearance of skin manifestations.
The drug may act negatively on the digestive system. This is expressed by nausea, diarrhea, anorexia, epigastric pain. Reducing the dose or cancellation of therapy contribute to the restoration of the previous state of the digestive tract. Large doses have a toxic effect on the liver and lead to a violation of its work.
Plavenil tablets and alcohol are considered incompatible, their simultaneous use may increase the symptoms of side effects.
There is a negative effect on the nervous system, with the following symptoms may be observed: dizziness, tinnitus, hearing loss, headache, irritability, emotional instability, sensory changes, decreased conduction of nerve fibers, psychosis, and convulsive state. Possible manifestations of muscle weakness, ataxia, myopathy of skeletal muscles, neuromyopathy, causing atrophy of the proximal muscle group.After discontinuation of the drug, it will take a couple of months to restore the former function of the muscular system.
The cardiovascular system may malfunction in the form of cardiomyopathy, with a violation of conductivity or thickening of the muscle wall of the ventricles of the heart, chronic cardiotoxicity. In these conditions, the abolition of the drug is required.
The drug may inhibit bone marrow hematopoiesis, cause aplastic anemia, agranulocytosis, decrease in the number of leukocytes and platelets.
Some people develop an allergic reaction to hydroxychloroquine, which is characterized by urticaria, angioedema, bronchospasm.
Pregnancy and lactation
According to many experts, the use of the drug "Plaquenil" during pregnancy is contraindicated. This is due to the penetration of hydroxychloroquine through the protection of the placental barrier. The action of 4-aminoquinoline causes intrauterine damage to the central nervous system, affects the auditory nerve, resulting in impaired hearing, the vestibular apparatus, deafness develops, retinal hemorrhage and abnormal pigmentation occur.
If you want to obtain the potential benefits of therapy for the mother's body, exceeding the risk for the unborn child, use Plavenil tablets for pregnant women.
The use of hydroxychloroquine when breastfeeding is also undesirable, since it penetrates into the milk and has a toxic effect of 4-aminoquinoline on the baby.
Contraindications for use
The use of the drug "Plaquenil" instructions for use indicates a number of contraindications. Under such conditions its use is prohibited. These include:
- hereditary violation of lactose digestibility, insufficient production of the enzyme lactase, galactosemia, when the conversion of galactose into glucose decreases;
- increased susceptibility of 4-aminoquinoline and its derivatives;
- carrying a child.
The drug is contraindicated in children, when long-term therapy is required and the development of a toxic effect is possible. Also, children up to the age of six with a body weight below 31 kg do not accept tablets whose dosage is 200 mg.
The pharmaceutical market is saturated with various drugs with a similar effect, which makes it possible to choose which medication to treat.
The drug "Plaquenil" analogues also has.They include the active component hydroxychloroquine or chloroquine, which are able to have an anti-inflammatory and moderate immunosuppressive effect. They are used for the treatment of malaria, rheumatic disease, lupus erythematosus.
Like the drug "Plaquenil", its analogues are available in tablet form with a protective shell.
One such drug based on hydroxychloroquine sulfate is Immard (200 mg tablets) manufactured by Ipka Laboratories Ltd, an Indian company. The auxiliary components of these two medicines are different, but the indications, the method of use, contraindications, adverse reactions are the same.
On the Russian market there is a Canadian counterpart under the trade name "Hydroxychloroquine". The manufacturer of this antimalarial drug is Apotex Inc. Its action is aimed at suppressing erythrocyte forms of malarial plasmodium, reducing the rate of free radical processes, slowing down the work of proteases, collagenases, leukocyte cells. This is how its immunosuppressive and anti-inflammatory effect is manifested.
The analogue of the drug "Plaquenil" - "Delagil" - belongs to the group of 4-aminoquinoline derivatives, antimalarial and amoebicidal agents, has the properties of an immunosuppressant. The tablets are produced by CJSC Alkaloid Chemical Company for the Hungarian-German company MEDA Pharma GmbH & Co. KG. Unlike the drug "Plaquenil", the composition of its analogue includes the active substance chloroquine phosphate, which, like hydroxychloroquine, kills asexual erythrocyte forms of plasmodia due to the effect on the properties of the DNA molecules of the causative agent of malaria. Chloroquine also has a gametocidal effect.
Indications for use of the drug "Delagil" include the treatment of extraintestinal amebiasis, amoebic liver abscess, scleroderma, photodermatosis, which are not in the instructions for use of the original means, indicating a wider effect of chloroquine phosphate.
The English company Sanofi-Sintelabo Ltd is the manufacturer of the original drug Plaquenil, the price for one such package with 60 tablets starts from 1,150 rubles. For many patients, especially those who require long-term systematic treatment, this medicine may not be affordable.In this case, the attending physician prescribes cheaper counterparts, which are sold in pharmacies and have similar indications for use.
Thus, the cost of one package of the Indian drug Immard (30 tablets) is about 445 rubles. For one bottle of 60 tablets of the Canadian drug "Hydroxychloroquine" you need to pay from 680 rubles, which is two times cheaper than the English form.
As you can see, the price for the drug Plaquenil is much higher compared to the cost of generic drugs, which are reproduced in the likeness of the original. However, it is not recommended to replace one medicine with another, it is necessary to consult a doctor.