In patients with SLE, neither the SLEDAI nor serum markers of SLE disease activity correlated with HCQ levels. More studies are needed to understand if hydroxychloroquine helps prevent pregnancy complications. Accompanying texts should be consulted for further details. Hydroxychloroquine (Plaquenil) and prednisone are considered safe during pregnancy. Exercise caution when administering hydroxychloroquine to nursing women; When administered to nursing women, hydroxychloroquine is excreted in human milk and it is known that infants are extremely sensitive to the toxic effects of 4-aminoquinolines; Pregnancy Categories. Pregnancy exposure registries collect and maintain data on the effects of approved drugs that are prescribed to and used by pregnant women. Note: Doses are expressed in terms of hydroxychloroquine base: 400-mg tablet = 310-mg base; 800-mg tablet = 620-mg base Acute Malaria Adult: PO 620-mg base followed by 310-mg base at 6, 18, and 24 h Child: PO 10-mg base/kg, then 5-mg base/kg at 6, 18, and 24 h Malaria Suppression This use has shown that HCQ is very safe in pregnancy. However, in multiple studies, hydroxychloroquine use has not been associated with congenital disabilities, stillbirth, prematurity, low birth weight, fetal death, or retinopathy following maternal intake at recommended … No ocular toxicity or growth abnormalities were found at 1-year follow-up of the infants.After 5 mothers took 200 mg/day during pregnancy and breastfeeding (1 for 30 months), flash electroretinograms performed on the infants were normal.A group of investigators have reported numerous infants whose mother took this drug during pregnancy and were breastfed during maternal use. These flaws make interpretation of some of the data difficult. According to author estimation, the 2 infants would receive 0.06 and 0.2 mg/kg/day. PLAQUENIL (hydroxychloroquine sulfate) tablets contain 200 mg hydroxychloroquine sulfate, equivalent to 155 mg base, and are for oral administration. It is taken by mouth, often in the form of hydroxychloroquine sulfate. Embryonic deaths and ocular malformations in the offspring have been reported when pregnant rats received large doses of chloroquine. The paradox that high serum levels > 500 ng/ml were likewise associated with both poor pregnancy outcome and higher disease activity remains confusing. The authors of the aforementioned study should be lauded for their efforts to obtain serum levels of HCQ in 3 trimesters of pregnancy, demonstrating a proof of concept that this is a feasible approach to SLE pregnancy management11. Some studies have not been clear regarding salt form and dose of the products used and others have sampled milk after only a few doses before steady state was reached, making interpretation of some of the data difficult.In a patient starting therapy with 200 mg (salt unspecified) twice a day, the highest milk level detected was 10.6 mcg/L from 3 to 12 hours after the fourth dose. In the non-SLE patient group, neither disease activity nor pregnancy outcome was related to HCQ levels; however, the numbers of subjects in each diagnostic subcategory were so small that no definitive conclusions could be drawn. It is generally recommended for pregnant patients with an autoimmune disease. Both adults and children should take one dose of hydroxychloroquine per week starting at least 1 week . The role of hydroxychloroquine (HCQ) for achieving this control is now recognized. In patients with SLE, disease activity was assessed by physician’s global assessment (PGA); SLE Disease Activity Index (SLEDAI) scores; and C3, C4, and dsDNA levels. There are no controlled data in human pregnancy; however, a moderate amount of data on pregnant women (between 300 and 1000 pregnancy outcomes), including prospective studies in long-term use with large exposure, have not shown a significant increase in risk of congenital malformations or poor pregnancy outcomes.Therapeutic doses of 4-aminoquinolines have been associated with central nervous system damage, including ototoxicity (auditory and vestibular toxicity, congenital deafness), retinal hemorrhages, and abnormal retinal pigmentation.According to the US CDC, this drug is a recommended agent for the treatment of chloroquine-sensitive malaria species during pregnancy; it is also recommended as an alternative for malaria prophylaxis during pregnancy for women traveling to areas where chloroquine-resistant Plasmodium falciparum has not been reported.Malaria in pregnant women increases the risk for adverse pregnancy outcomes, including prematurity, spontaneous abortion, and stillbirth. Doses (as sulfate) ranged from 200 mg once every 2 days to 200 mg twice a day, with most taking 200 mg once (24%) or twice (64%) a day; these doses are equivalent to 155 and 310 mg base. A pregnancy was considered unexposed to HCQ if the drug was never taken or was discontinued before 10 weeks of gestation. Feldman, et al used claims data to show that 79% of nonpregnant patients with SLE are nonadherent7. Hydroxychloroquine does cross the placenta and is considered Category D in pregnancy (see DermNet NZ's pages on Safety of medicines taken during pregnancy and on Lactation and the skin). Centers for Disease Control "Guidelines for Treatment of Malaria in the United States. Introduction. This study is a good start in understanding the relationship between HCQ levels, disease activity, and pregnancy outcome11, and suggests that maybe we ought to be focusing on drug levels rather than the dose of HCQ in our patients with SLE, whether pregnant or not. Anti-malarial drugs (hydroxychloroquine, chloroquine) are considered pregnancy category C drugs. Other uses include treatment of rheumatoid arthritis, lupus, and porphyria cutanea tarda. Data are limited regarding the use of hydroxychloroquine during pregnancy. Select one or more newsletters to continue. Therapy may include low dose prednisolone [2], azathioprine [5], and /or hydroxychloroquine [6 - 8] as these have proved safe and efficacious in pregnancy [5]. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. To circumvent the possible effect of medication nonadherence on the understanding of the role of HCQ in rheumatic disease management, literature has focused on the measurement of either whole blood or serum drug levels and correlating these levels to disease activity. In this trial, the investigators want to evaluate the efficacy of the combination of Favipiravir and Hydroxychloroquine as potential therapy for moderate and severe cases with COVID -19. Further studies into the pharmacokinetics of HCQ in the pregnant and nonpregnant state will also be important. Even if it is generally agreed that pregnancy per se increases disease activity in patients with SLE and that withdrawal of HCQ at the onset of pregnancy may result in exacerbation of SLE, use of HCQ during pregnancy has remained controversial for a long time. These paradoxical findings could reflect that the patients in the > 500 ng/ml group may have been sicker. Hydroxychloroquine passes through breast milk. The authors found significant intrasubject variability in serum HCQ during pregnancy11. hydroxychloroquine sulfate) is an arthritis medicine . Twenty-eight patients had SLE, 7 had rheumatoid arthritis or juvenile idiopathic arthritis, 5 had connective tissue disease, and the remaining 10 had other rheumatic and autoimmune disorders. The aim of our trial is to determine whether hydroxychloroquine given to COVID-19 positive pregnant women can reduce COVID-19-related hospital admissions, thereby allowing women to stay at home while limiting utilization of … This observational, retrospective, single-centre cohort study aimed to assess pregnancy outcome in women with antiphospholipid antibody(aPL) treated with hydroxychloroquine (HCQ) in addition to conventional treatment during pregnancy. "Product Information. See references. Hydroxychloroquine is usually considered a pregnancy Category C medication. In 1 study, daily drug exposures to infants from breast milk were estimated to be less than 2% of the maternal dose (after adjusting for body weight).Infants exposed to this drug during breastfeeding receive only small amounts of the drug. AU TGA pregnancy category: D US FDA pregnancy category: Not formally assigned to a pregnancy category. Prasco Laboratories, Cincinnati, OH. There is evidence that HCQ may be safe during pregnancy, with previous research finding no increased risk of, prematurity, fetal death, retinopathy, low birth weight, stillbirth, or congenital defects[2-4]. But these studies have not provided overwhelming evidence proving the safety of this agent in pregnancy, Jean-Charles Piette, M.D., said at an international conference on cutaneous lupus … Several studies demonstrate that patients with SLE who continue HCQ during pregnancy have decreased flares and improved pregnancy outcomes, including longer fetal gestation and … Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. We recommend that all women with lupus should be advised to take hydroxychloroquine in pregnancy unless it is contraindicated (1C). The Pregnancy subsection (8.1) includes information for a pregnancy exposure registry for the drug when one is available. The finding that nontherapeutic levels of HCQ were associated with a higher frequency of lower gestational age and more preterm delivery supports the authors’ conclusion that targeting strategies to improve HCQ adherence in pregnancy may improve outcome, although the lack of linear correlation between HCQ level and gestational age suggests that this relationship is complex. Available from: URL: https://www.cdc.gov/malaria/resources/pdf/Malaria_Treatment_Table_120419.pdf." Abstract. OBJECTIVE: To determine the safety for both mother and fetus of antimalarial drugs, i.e., chloroquine and hydroxychloroquine, in pregnant patients with lupus who continued antimalarial drugs throughout pregnancy. For the topic Coronavirus, go here.These expert reports are free of charge and can be saved and shared. A study of women with aPL who were taking hydroxychloroquine (HCQ) during pregnancy to treat lupus found that women taking HCQ had a better pregnancy outcome compared to women who do not take it, with fewer miscarriages and preterm births and a higher live birth rate. 1,2 Hydroxychloroquine, sold under the brand name Plaquenil among others, is a medication used to prevent and treat malaria in areas where malaria remains sensitive to chloroquine. Hydroxychloroquine is usually considered a pregnancy Category C medication. These medications are not usually taken together. in early pregnancy is essential to reduce these risks. B: May be acceptable. HCQ levels were categorized as nontherapeutic (< 100 ng/ml) or therapeutic (> 100 ng/ml). Recently, some countries face restrictions to prescribe these drugs during pregnancy, due to report of ocular toxicity in animal models and potential genotoxicity. pregnant women and nursing mothers. HCQ appears more promising than chloroquine due to its greater effectiveness against SARS-CoV-2 … of botulinum toxin, which can have decreased efficacy if taken with hydroxychloroquine. A: Generally acceptable. The optimal duration of therapy to achieve steady state, timing of blood draw in relation to dose administration, changes in pharmacokinetics because of pregnancy, and disease factors still represent unresolved issues. Hydroxychloroquine in particular is associated with improved obstetric outcomes in SLE [9]. Several studies demonstrate that patients with SLE who continue HCQ during pregnancy have decreased flares and improved pregnancy outcomes, including longer fetal gestation and infants with higher birth weight3,4. Several studies demonstrate that patients with SLE who continue HCQ during pregnancy have decreased … In a case series, 13 mothers taking 200 mg/day (as sulfate) breastfed their infants for an average of 2.8 months (range: 1 to 6 months); no infant had evidence of retinal, motor, or growth abnormalities during 12 months of follow-up. ([2019, Oct 1]): Centers for Disease Control and Prevention "Travel-Related Infectious Diseases. Hydroxychloroquine (HCQ) is often needed to manage disease activity in systemic lupus erythematosus (SLE) during pregnancy. Database search . Although the authors found a statistically significant relationship between HCQ levels and disease activity as measured by the PGA, the r2 of 0.07 reflects a nonlinear relationship. 292 Hydroxychloroquine does appear in breast milk, but the amount ingested per day by the breast-feeding infant would be very low. O 0, Cerner Multum, Inc. "UK Summary of Product Characteristics." Note: The Pregistry website includes expert reports on more than 2000 medications, 300 diseases, and 150 common exposures during pregnancy and lactation. Hydroxychloroquine is being studied to prevent and treat coronavirus disease 2019, but all clinical trials conducted during 2020 found it is ineffective and may c Costedoat-Chalumeau, et al were among the first to show that HCQ concentration could predict disease activity, with whole blood drug levels of > 1000 ng/ml having a high negative predictive value of flare9. This drug has a half-life of over 1 month. Comparing these approaches head to head may clarify this point. Hydroxychloroquine is also known as: Plaquenil, Quineprox. For pregnant patients, it is recommended to continue use for those patients with SLE, as it leads to less flare-ups and has not been shown to be teratogenic in some trials. Hydroxychloroquine and prednisone are considered safe during pregnancy. Eighty-three percent of patients in this group compared to 12% in the suboptimal therapeutic group and 16.7% in the nontherapeutic groups were taking azathioprine (AZA), suggesting that these patients may have had disease that is more complex. Too Little of a Good Thing: Hydroxychloroquine in Pregnancy, DOI: https://doi.org/10.3899/jrheum.181046, Influence of disease activity and medications on offspring birth weight, pre-eclampsia and preterm birth in systemic lupus erythematosus: a population based study, Rheumatoid arthritis and pregnancy: beyond smaller and preterm babies, Effect of pregnancy on disease flares in patients with systemic lupus erythematosus, Feasibility of hydroxychloroquine adjuvant therapy in pregnant women with systemic lupus erythematosus, BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids, Survey of antimalarial use in lupus pregnancy and lactation, Medication nonadherence is associated with increased subsequent acute care utilization among Medicaid beneficiaries with systemic lupus erythematosus, Trends in use of hydroxychloroquine during pregnancy in systemic lupus erythematosus patients from 2001–2015, Low blood concentration of hydroxychloroquine is a marker for and predictor of disease exacerbations in patients with systemic lupus erythematosus, Hydroxychloroquine serum concentrations and flares of systemic lupus erythematosus: A longitudinal cohort analysis, Hydroxychloroquine levels throughout pregnancies complicated by rheumatic disease: implications for maternal and neonatal outcomes, Retardation of fetal growth in patients receiving immunosuppressive therapy, Relapsing Polychondritis and Large-vessel Vasculitis. 300 It seems reasonable for a mother taking hydroxychloroquine to breastfeed if she had taken hydroxychloroquine during pregnancy. However, several studies of the medication have not shown any increase in the rates of adverse effects for mother or baby. UT Southwestern Medical Center, Division of Rheumatic Diseases, Dallas, Texas, Sign In to Email Alerts with your Email Address. OBJECTIVE: Systemic lupus erythematosus (SLE) increases the risk of complications in pregnancy. O 0. As the authors point out, while whole blood testing may be more precise, serum levels may have the advantage of being less prone to confounding by cytopenias11. Hydroxychloroquine levels in the two mothers were 344 and 1424 mcg/L at unspecified times after a dose. Peak milk level was reached 2 to 4 hours after dosing. Chloroquine and hydroxychloroquine (HCQ) have demonstrated activity against SARS-coronaviruses in laboratory studies and are being tested in COVID-19 positive patients. The relative merits of whole blood versus serum measurement of HCQ are unknown. Reassuringly, antimalarials are compatible with pregnancy, with no signals for safety concerns, and professional society guidelines recommend continuation of HCQ during pregnancy5. To the Editor.— In their excellent review article Tanenbaum and Tuffanelli 1 mention pregnancy as a contraindication to the use of chloroquine phosphate. It is taken by mouth. Other uses include treatment of rheumatoid arthritis, lupus, and porphyria cutanea tarda. This systematic review contains a meta-analysis of the available clinical studies investigating the use of HCQ during pregnancy and will focus on the risk of congenital defects, number of live births, spontaneous abortions, fetal deaths and pre-maturity in fetuses born to women taking HCQ. Most cases of RPL are unexplained and have no effective treatment to improve the chance of a live birth. A relative infant dose of 9.8% was found in 1 woman taking 200 mg twice a day; she was instructed to discontinue breastfeeding. BREAST FEEDING COMPATIBILITY. The purpose of this study was to examine lupus activity and pregnancy outcomes in women with SLE treated or not treated with HCQ during pregnancy. Thank you for your interest in spreading the word about The Journal of Rheumatology. Hydroxychloroquine crosses the placenta but is considered safe to use during pregnancy. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. After the first 48 hours of therapy with a total dosage of 800 mg, a total of 3.2 mcg was excreted into her breast milk, amounting to 0.0003% of the mother's total dosage; however, it is unlikely that steady state had been reached at this time.A woman who had been breastfeeding for 9 months began taking 400 mg (as sulfate equivalent to 310 mg base) nightly; after 6 weeks of this regimen, steady-state milk levels were 1.46, 1.09, and 1.09, at 2, 9.5, and 14 hours after 1 dose, respectively, and 0.85 mg/L at 17.7 hours after a dose on the following day. [1,15] Another group of investigators have reported numerous infants whose mother took hydroxychloroquine during pregnancy and were breastfed during maternal hydroxychloroquine use. It is sold under the brand name Plaquenil and it is also sold as a generic medicine. In humans, a small number of studies using hydroxychloroquine sulfate during pregnancy The authors also found a higher frequency of infants preterm born to mothers with a serum level of HCQ < 100 ng/ml compared to those with therapeutic levels of HCQ (> 100 ng/ml; p = 0.01)11. The use of hydroxychloroquine in pregnancy without an increase in the rate of birth defects has been reported in the literature. This medication belongs to a group of drugs called DMARDs (disease modifying antirheumatic drugs) which work by suppressing the excessive activity of the immune system. Additionally, other small studies have shown that hydroxychloroquine is excreted through breastmilk. It concluded that drug levels themselves cannot differentiate noncompliance from other pharmacokinetic factors10. This drug should not be used during pregnancy unless the benefit outweighs the risk to the fetus.AU TGA pregnancy category: DUS FDA pregnancy category: Not formally assigned to a pregnancy category. This study was unable to establish a statistically significant relationship between serum level of HCQ and disease activity. The role of hydroxychloroquine (HCQ) for achieving this control is now recognized. Mok, et al measured HCQ levels in sera and defined 3 groups of patients based on drug level: those with drug levels < 10 ng/ml were classified as noncompliant; those with levels of 10–500 ng/ml were classified as having subtherapeutic drug levels; and a third group with levels > 500 ng/ml were classified as having therapeutic levels. Talk to your healthcare provider about the risks and benefits of using hydroxychloroquine during pregnancy (see Plaquenil and Pregnancy for more information). Some studies have not been clear about the salt form and dosage of the products being taken and others have sampled milk after only a few doses before steady state was reached. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Primary outcome for this study was neonatal gestational age. We studied whether HCQ was associated with lower odds of preeclampsia and preterm delivery in SLE … Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Hydroxychloroquine sulfate is a colorless crystalline solid, soluble in water to at least 20 percent; chemically the drug is 2-[[4-[(7-Chloro-4-quinolyl) amino]pentyl] ethylamino] ethanol sulfate (1:1). One possible explanation for this poor correlation is that the mean PGA among the patients with SLE was < 1.0 in all 3 HCQ therapeutic ranges, reflecting overall low disease activity in this cohort. We do not capture any email address. Twenty-four percent of patients had at least 1 HCQ level < 100 ng/ml, suggesting a high rate of nonadherence. According to author estimation, a fully breastfed infant would receive 1 mg of parent drug and 0.066 mg of desethylchloroquine per day.At 7 time points between 0 and 18 hours after dosing, 13 women who were on long-term therapy donated milk samples. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. DÜSSELDORF, GERMANY — The anti-inflammatory compound hydroxychloroquine appears to be relatively safe during pregnancy, according to a small number of studies totaling about 250 patients. Objective: The use of hydroxychloroquine (HCQ) in pregnancy remains controversial. The authors measured serum levels of HCQ in all 3 trimesters and related these levels to disease activity and pregnancy outcomes. Sanofi Winthrop Pharmaceuticals, New York, NY. Who should not take hydroxychloroquine? High disease activity for patients with SLE was defined as a PGA > 1.0. Likewise, the pregnancy category for medicines registered for use in men only is also presented for information purposes only. No adverse effects were reported in her 9-month-old breastfed infant.After taking 200 mg (probably sulfate equivalent to 150 mg base) once or twice a day (report was unclear) before and during pregnancy, 2 women had milk levels measured after delivery; drug levels were 344 and 1424 mcg/L at unspecified times after dosing. Data are limited regarding the use of hydroxychloroquine during pregnancy. Two women who had taken hydroxychloroquine 200 mg (probably sulfate equivalent to 150 mg of base) once or twice daily (the report is unclear) before and during pregnancy had milk levels measured after delivery. Hydroxychloroquine, sold under the brand name Plaquenil among others, is a medication used to prevent and treat malaria in areas where malaria remains sensitive to chloroquine. Use of chloroquine and hydroxychloroquine in pregnancy was not associated with adverse fetal outcomes. Milk drug levels averaged 416 mcg/L in 1 woman taking 100 mg/day, 358 to 746 mcg/L in 3 women taking 100 mg twice a day, 672 to 980 mcg/L in 4 women taking 200 mg once a day, and 1336 to 3269 mcg/L in 5 women taking 200 mg twice a day.Milk drug levels were determined at 5 times over a 12-hour period just before and after dosing in 33 women who had been taking this drug for at least 1 year and were exclusively breastfeeding; samples were collected at a median of 4 weeks postpartum (range: 1 to 16 weeks postpartum). HCQ has anti-inflammatory and anti-thrombotic effects and thus may improve pregnancy outcomes in couples with unexplained RPL. Malaria. The recent demonstration that HCQ passes across the placenta, with cord blood concentrations nearly identical to those found in maternal blood, emphasizes the need for careful evaluation of pregnancies in women receiving HCQ. The recent demonstration that HCQ passes across the placenta, with cord blood concentrations nearly identical to those found in maternal blood, emphasizes the need for … It appears the 8 infants reported in the letter were included among the 13 infants in the case series, but it is unclear whether the 16 infants reported in the abstract were part of the case series. Travel to malarious areas should be avoided during pregnancy; if this is not possible, women should receive effective prophylaxis.AU TGA pregnancy category D: Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. Hydroxychloroquine … Additional data assessed included the mother's age at the time of birth, mother's race/ethnicity, maternal diagnosis at the time of subsequent pregnancy, and anti-SSA/Ro-SSB/La antibody status. The change in recommendations is based on the recent Food and Drug Administration (FDA) re-categorization of mefloquine from a pregnancy category C drug to category B, based on their review of the published data on mefloquine use during pregnancy. For many decades it has been given to: pregnant women, breastfeeding women, children, elderly patients, immune compromised patients and healthy persons. Anti-malarial drugs (hydroxychloroquine, chloroquine) are considered pregnancy category C drugs. These data showed that pregnant women who took mefloquine at various doses for both prevention and treatment of malaria did not have an … 293 It seems reasonable for the mother taking hydroxychloroquine to breast feed if she had taken hydroxychloroquine during pregnancy. Although some providers are already … Hydroxychloroquine in Pregnancy Women with rheumatic diseases, including inflammatory arthritis and systemic lupus erythematosus (SLE), fare better in pregnancy when their disease is under good control1,2. ([2019, Dec 11]): "Product Information. According to author estimation, the infant would receive 0.11 mg/kg/day or about 2% of the mother's weight-adjusted dose. Could Disease Activity Score in 28 Joints–Gamma-glutamyl Transferase Use Improve Cardiovascular Disease Risk Management in Rheumatoid Arthritis. Thus, low adherence to HCQ confounds conclusions regarding this drug’s effect on disease control and pregnancy outcome in SLE. Despite the recognition that HCQ is a key component of SLE disease management in both nonpregnant and pregnant patients, adherence to HCQ remains abysmally low. Additionally, women need to know which medications should be established pre-pregnancy (for example, hydroxychloroquine), and ensure that their blood pressure is controlled. Recurrent pregnancy loss (RPL) defined as 3 or more pregnancy losses affects approximately 3% of couples trying to achieve parenthood. The use of hydroxychloroquine (HCQ) in pregnancy remains controversial. People with psoriasis should not take hydroxychloroquine. Flash electroretinograms performed on the infants were normal. Hydroxychloroquine does cross the placenta and is considered Category D in pregnancy (see DermNet NZ's pages on Safety of medicines taken during pregnancy and on Lactation and the skin). _____ Lately, we’ve been hearing a lot about using a drug called hydroxychloroquine in the fight against COVID-19. COVID-19 and Immunomodulatory Therapy — Can We Use Data from Previous Viral Pandemics? PLAQUENIL (hydroxychloroquine sulfate) tablets contain 200 mg hydroxychloroquine sulfate, equivalent to 155 mg base, and are for oral administration. This means that it may not be safe for use during pregnancy, although the full risks are not known. Hydroxychloroquine (HCQ) is a medication commonly used in pregnancy to treat autoimmune and connective tissue diseases such as systemic lupus erythematosus (SLE). Embryonic deaths and ocular malformations in the offspring have been reported when pregnant rats received large doses of chloroquine. National Library of Medicine (US) "Drugs and Lactation Database (LactMed) Available from: URL: https://www.ncbi.nlm.nih.gov/books/NBK501922/" (2006). Rationale . While there is evidence of risk for damage to the eye and ear, if the benefits of these drugs in controlling RA symptoms are judged to outweigh the risks, they may continue to be used during pregnancy. Hydroxychloroquine (Plaquenil) is used to treat malaria, lupus, and rheumatoid arthritis. It is available in tablets of 155mg base (200mg salt). Among the SLE pregnancies, those with nontherapeutic levels of HCQ (< 100 ng/ml) had a higher frequency of infants with lower gestational age (p = 0.03); however, the authors were unable to demonstrate a linear association between HCQ serum level and gestational age. In support of this approach, a survey of North American rheumatologists found that over 69% of rheumatologists continued HCQ in their pregnant patients6. This use has shown that HCQ is very safe in pregnancy. Due to pregnancy-induced physiologic changes, some pharmacokinetic properties of hydroxychloroquine may be altered in pregnant women; however, dosage adjustments are not needed (Balevic 2019b). ([2019, Jul 1]): Centers for Disease Control and Prevention "Treatment of Malaria: Guidelines For Clinicians (United States) Available from: URL: https://www.cdc.gov/malaria/diagnosis_treatment/clinicians1.html." Although human studies are lacking, available evidence suggests a relatively low risk to the fetus. A: Generally acceptable. Hydroxychloroquine (HCQ) decreases flares and neonatal lupus syndrome. Hydroxychloroquine sulfate is a colorless crystalline solid, soluble in water to at least 20 percent; chemically the drug is 2-[[4-[(7-Chloro-4-quinolyl) amino]pentyl] ethylamino] ethanol ... Usage in Pregnancy—Usage of this drug during pregnancy should be avoided except in Diseases, Dallas, Texas, Sign in to Email alerts with your Email.... Considered safe during pregnancy to achieve parenthood serum levels > 500 ng/ml were associated. Of this drug about the Journal of Rheumatology Fact Sheet, version date 3/28/20 suggests that HCQ also reduces and. 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