Interactions between Hydroxychloroquine and Peginterferon alfa-2a

Hydroxychloroquine has a moderate potential interaction with Alcoholism.

Aminoquinolines may concentrate in the liver. Isolated cases of abnormal liver function and fulminant hepatic failure have been reported. Therapy with aminoquinolines should be administered cautiously in patients with hepatic disease or alcoholism and in patients receiving other hepatotoxic drugs. Periodic evaluation of hepatic function should be performed during prolonged therapy.

Hydroxychloroquine has a moderate potential interaction with Arrhythmia.

The use of 4-aminoquinolines such as hydroxychloroquine and chloroquine prolong the QT interval. Ventricular arrhythmias and torsades de pointes have been reported in patients taking these agents. Care should be exercised in patients with a prolonged QT interval at baseline or at increased risk for arrythmia. A baseline electrocardiogram should be obtained to assess for QT interval prolongation and other abnormalities. It is recommended to use appropriate diagnostic tools such as ECG to monitor patients during therapy.

Peginterferon alfa-2a has a major potential interaction with Autoimmune Disorders.

Antiviral interferons may exacerbate autoimmune disorders such as myositis, thyroiditis, systemic lupus erythematosus, rheumatoid arthritis, psoriasis, or autoimmune hepatitis. Therapy should be avoided or administered with extreme caution in patients with autoimmune disorders.

Peginterferon alfa-2a has a major potential interaction with Autoimmune Hepatitis.

The use of peginterferons alfa are contraindicated in patients with autoimmune hepatitis.

Hydroxychloroquine has a moderate potential interaction with Bone Marrow Depression/Low Blood Counts.

Adverse hematologic effects including neutropenia, agranulocytosis, aplastic anemia, and thrombocytopenia have been rarely associated with 4-aminoquinolines. Therapy with 4-aminoquinolines should be administered cautiously in patients with preexisting bone marrow suppression. A complete blood count should be performed periodically in patients on prolonged therapy. If any severe blood disorder appears which is not attributable to the disease under treatment, discontinuance of the drug should be considered.

Hydroxychloroquine has a moderate potential interaction with Cardiomyopathy.

Cardiomyopathy has been rarely reported with high daily dosages of hydroxychloroquine. Therapy with hydroxychloroquine should be monitored in patients with heart conditions. If cardiotoxicity is suspected, it is recommended to discontinue treatment with hydroxychloroquine to prevent life-threatening complications.

Peginterferon alfa-2a has a major potential interaction with Cardiovascular Conditions and Disorders.

Hypertension, arrhythmias, angina, myocardial infarction, cardiomyopathy, and congestive heart failure have been reported during interferon therapy. Therapy with interferons should be administered with caution in patients with compromised cardiac function.

Peginterferon alfa-2a has a major potential interaction with Cirrhosis.

The use of peginterferons alfa are contraindicated in patients with hepatic decompensation (Child-Pugh score greater than 6, class B or C) in cirrhotic patients before treatment, and in patients with hepatic decompensation (Child-Pugh score greater or equal to 6) that have chronic hepatitis C coinfected with HIV.

Peginterferon alfa-2a has a major potential interaction with Depression.

Life-threatening or fatal neuropsychiatric reactions have been reported in patients receiving peginterferons alfa, including suicide, suicide ideation, homicidal ideation, depression, relapse of drug addiction, and drug overdose. These reactions have occurred in patients with and without previous psychiatric illness. These drugs should be used with extreme caution in patients with a history of depression. Other events reported include aggressive behavior, psychosis, hallucinations, bipolar disorder and mania. Patients should be monitored for any evidence of depression or other psychiatric symptoms, and they should be advised to report any signs or symptoms of depression or other changes in mood or behavior. In severe cases, therapy should be stopped immediately and psychiatric intervention should be instituted.

Hydroxychloroquine has a moderate potential interaction with Diabetes Mellitus.

Hydroxychloroquine has been shown to cause severe hypoglycemia including loss of consciousness that could be life threatening in patients treated with or without antidiabetic. Care should be exercised when using hydroxychloroquine in diabetic patients. Patients presenting with clinical symptoms suggestive of hypoglycemia during treatment with hydroxychloroquine should have their blood glucose checked and treatment instituted as necessary.

Peginterferon alfa-2a has a moderate potential interaction with Diabetes Mellitus.

Peginterferons alfa can cause or aggravate hypothyroidism, hyperthyroidism, hyperglycemia, hypoglycemia and diabetes mellitus. Treatment should be administered with caution on patients with these conditions. Treatment should not be initiated if the condition cannot be effectively treated by medication. Therapy should be discontinued if any of these conditions develops during treatment and it cannot be controlled with medication.

Hydroxychloroquine has a moderate potential interaction with G-6-PD Deficiency.

Hemolysis and acute renal failure have been reported during use of aminoquinolines in patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. Therapy with aminoquinolines should be administered cautiously in these patients. Blood cell counts and hemoglobin determinations should be performed regularly. Aminoquinoline therapy should be discontinued immediately if signs suggestive of hemolytic anemia occur, such as marked darkening of the urine or sudden decrease in hemoglobin concentration or erythrocytic count.

Hydroxychloroquine has a moderate potential interaction with Hearing Loss.

The use of 4-aminoquinolines has been associated rarely with ototoxicity. Nerve-type deafness, which is usually irreversible, has occurred during long-term, high-dose therapy. Deafness may not be apparent until several weeks after 4-aminoquinoline therapy. Tinnitus and reduced hearing have been reported in patients with preexisting auditory damage. Therapy with 4-aminoquinolines should be administered cautiously in such patients. If new auditory defects develop or if hearing loss becomes worse, therapy should be immediately discontinued and the patient closely monitored.

Peginterferon alfa-2a has a major potential interaction with HIV-1 Infection.

The use of peginterferons alfa are contraindicated in patients with hepatic decompensation (Child-Pugh score greater than 6, class B or C) in cirrhotic patients before treatment, and in patients with hepatic decompensation (Child-Pugh score greater or equal to 6) that have chronic hepatitis C coinfected with HIV.

Peginterferon alfa-2a has a moderate potential interaction with Hyperthyroidism.

Peginterferons alfa can cause or aggravate hypothyroidism, hyperthyroidism, hyperglycemia, hypoglycemia and diabetes mellitus. Treatment should be administered with caution on patients with these conditions. Treatment should not be initiated if the condition cannot be effectively treated by medication. Therapy should be discontinued if any of these conditions develops during treatment and it cannot be controlled with medication.

Hydroxychloroquine has a moderate potential interaction with Hypoglycemia.

Hydroxychloroquine has been shown to cause severe hypoglycemia including loss of consciousness that could be life threatening in patients treated with or without antidiabetic. Care should be exercised when using hydroxychloroquine in diabetic patients. Patients presenting with clinical symptoms suggestive of hypoglycemia during treatment with hydroxychloroquine should have their blood glucose checked and treatment instituted as necessary.

Peginterferon alfa-2a has a moderate potential interaction with Hypoglycemia.

Peginterferons alfa can cause or aggravate hypothyroidism, hyperthyroidism, hyperglycemia, hypoglycemia and diabetes mellitus. Treatment should be administered with caution on patients with these conditions. Treatment should not be initiated if the condition cannot be effectively treated by medication. Therapy should be discontinued if any of these conditions develops during treatment and it cannot be controlled with medication.

Hydroxychloroquine has a moderate potential interaction with Liver Disease.

Aminoquinolines may concentrate in the liver. Isolated cases of abnormal liver function and fulminant hepatic failure have been reported. Therapy with aminoquinolines should be administered cautiously in patients with hepatic disease or alcoholism and in patients receiving other hepatotoxic drugs. Periodic evaluation of hepatic function should be performed during prolonged therapy.

Hydroxychloroquine has a moderate potential interaction with Myasthenia Gravis.

Certain aminoquinolines such as chloroquine, and hydroxychloroquine should be used with caution in patients with myasthenia gravis (MG). These agents may exacerbate or trigger new onset of symptoms in patients with previously diagnosed MG. It is recommended to advise patients with MG about this possible side effect.

Peginterferon alfa-2a has a moderate potential interaction with Neutropenia.

Peginterferons alfa suppress bone marrow function and may result in severe cytopenias. Very rarely, it may be associated with aplastic anemia. These drugs should be used with caution in patients with baseline neutrophil counts less than 1,500 cells/mm3, with platelet counts less than 90,000 cells/mm3 or baseline hemoglobin less than 10 g/dL. It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy. Neutropenia and thrombocytopenia occur with greater incidence in patients coinfected with HIV.

Hydroxychloroquine has a major potential interaction with Porphyria.

The use of aminoquinolines in patients with porphyria may exacerbate the condition. Aminoquinolines should not be used in these patients unless the potential benefits are anticipated to outweigh the risks.

Hydroxychloroquine has a moderate potential interaction with Psoriasis.

The use of aminoquinolines in patients with psoriasis may precipitate a severe attack of psoriasis. Aminoquinolines should not be used in these patients unless the potential benefits are anticipated to outweigh the risks.

Peginterferon alfa-2a has a moderate potential interaction with Pulmonary Impairment.

Dyspnea, pulmonary infiltrates, pneumonia, bronchiolitis, pulmonary hypertension, and other pulmonary disorders resulting in respiratory failure and/or death may be induced or aggravated by alpha interferon therapy. Caution should be used when used in patients with preexisting pulmonary disorders.

Peginterferon alfa-2a has a major potential interaction with Renal Dysfunction.

Proteinuria (rare), not associated with a decrease in serum protein, is the most common renal toxicity observed with interferon- alfa therapy. Increased BUN and serum creatinine levels, hematuria, acute renal failure and nephrotic syndrome have also been reported. Therapy with interferon alfa should be administered cautiously to patients with severe renal dysfunction. Renal function should be evaluated in all patients before initiation of interferon- alfa therapy. In addition, patients with any degree of renal impairment should be carefully monitored for laboratory abnormalities and decreased creatinine clearance. A reduced dose of medication is recommended in patients with low CrCl (less than 50 mL/min - 30 mL/min).

Hydroxychloroquine has a moderate potential interaction with Renal Dysfunction.

Hydroxychloroquine is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. A dosage adjustment is not required for patients with renal impairment. Caution and monitoring should be exercised in patients with impaired renal function.

Hydroxychloroquine has a major potential interaction with Retinal Disorders.

The use of 4-aminoquinolines is generally considered contraindicated in the presence of retinal or visual field changes, whether attributable to 4-aminoquinoline compounds or to any other etiology. However, in the treatment of acute attacks of malaria caused by susceptible strains of plasmodia, these agents may be considered if potential benefits are anticipated to outweigh the risks. 4-aminoquinolines are oculotoxic and can cause dose-related, irreversible retinal damage and vision loss during and up to several years after long-term or high-dose therapy (e.g., in the treatment of systemic lupus erythematosus or rheumatoid arthritis). Ophthalmologic monitoring, including visual acuity, expert slit-lamp, funduscopic, and visual field tests, is recommended at baseline and every three months during prolonged use. Therapy should be discontinued immediately if abnormalities develop in visual acuity, visual field, or retinal macular areas (e.g., pigmentary changes, loss of foveal reflex), or if the patient experiences visual symptoms such as light flashes and streaks that are not fully explainable by difficulties of accommodation or corneal opacities. Other common symptoms that may indicate retinopathy include nyctalopia, photophobia, blurred distance vision, difficulty reading or seeing (e.g., words or letters disappearing or parts of objects missing; misty vision; fog before the eyes), and missing or blacked out areas in the central or peripheral visual field. Retinal changes and visual disturbances may progress even after cessation of therapy. However, in a number of patients, early retinopathy (macular pigmentation sometimes with central field defects) diminished or regressed completely after therapy was discontinued. Paracentral scotoma to red targets, sometimes termed premaculopathy, is indicative of early retinal dysfunction and is usually reversible with cessation of therapy.

Hydroxychloroquine has a moderate potential interaction with Seizures.

4-aminoquinolines may cause epileptic seizures in susceptible individuals. Patients with epilepsy or an otherwise low seizure threshold may be at greater risk. Therapy with 4-aminoquinolines, particularly chloroquine, should be administered cautiously in patients with epilepsy.

Peginterferon alfa-2a has a moderate potential interaction with Thrombocytopenia.

Peginterferons alfa suppress bone marrow function and may result in severe cytopenias. Very rarely, it may be associated with aplastic anemia. These drugs should be used with caution in patients with baseline neutrophil counts less than 1,500 cells/mm3, with platelet counts less than 90,000 cells/mm3 or baseline hemoglobin less than 10 g/dL. It is advised that complete blood counts be obtained pretreatment and monitored routinely during therapy. Neutropenia and thrombocytopenia occur with greater incidence in patients coinfected with HIV.

Peginterferon alfa-2a has a moderate potential interaction with Underactive Thyroid.

Peginterferons alfa can cause or aggravate hypothyroidism, hyperthyroidism, hyperglycemia, hypoglycemia and diabetes mellitus. Treatment should be administered with caution on patients with these conditions. Treatment should not be initiated if the condition cannot be effectively treated by medication. Therapy should be discontinued if any of these conditions develops during treatment and it cannot be controlled with medication.

Peginterferon alfa-2a has a moderate potential interaction with Visual Defect/Disturbance.

Decrease or loss of vision, retinopathy including macular edema, retinal artery or vein thrombosis, retinal hemorrhages and cotton wool spots, optic neuritis, papilledema, and serious retinal detachment can be induced or aggravated by alpha interferons. All patients should receive an eye examination at baseline and caution should be exercised in patients with preexisting ophthalmologic disorders. Patients should have periodic ophthalmologic exams during treatment.