Hydroxychloraquine-induced acute psychotic disorder in a female patient with rheumatoid arthritis: a case report

Altıntaş, Ebru

doi:10.5350/dajpn2015280409

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…In addition, HCQ and CQ tend to accumulate more easily in the adipose tissues of elderly patients due to diminished body hydration. 68,69 Therefore, symptoms may be present for longer and may present at lower doses than in adults and children. 68 Other possible risk factors are patients with auto-immune infectious disease, 8 epilepsy, 21 hepatic insufficiency, 60 hypoalbuminemia, 8 smoke, 17 alcohol intake, 8 low BMI, 8,21 and coadministration of drugs that interfere with the CYP450 enzyme family, 8,57,67 which plays an important role in the metabolism of these drugs in humans.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Psychiatric Adverse Effects Induced by Chloroquine and Hydroxychloroquine: Case Reports and Population Studies

et al. 2022

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Objective: To perform a systematic review on the psychiatric adverse effects of chloroquine (CQ) and hydroxychloroquine (HCQ); to summarize what is known about psychiatric adverse effects of these drugs; to compare clinical trials, populational studies, and case report studies; and to increase awareness of the potential psychiatric adverse effects of these drugs. Data Sources: A literature search of PubMed, Scopus, and Web of Science was performed to identify manuscripts published between December 1962 and June 2022. Search terms included CQ, HCQ, psychiatry, psychosis, depression, anxiety, bipolar disorder, delirium, and psychotic disorders. Study Selection and Data Extraction: Relevant studies included reports of adverse effects after CQ or HCQ ingestion. Data Synthesis: The current literature presents evidence for a risk of short-term psychiatric adverse effects induced by either CQ or HCQ. However, the populational-level studies presented some limitations regarding the voluntary response in survey data, self-report adverse effects, and placebo group reporting similar symptoms to the case group. Thus, populational-level studies addressing the discussed limitations and the nature and extent of possible psychiatric adverse effects are needed. Relevance to Patient Care and Clinical Practice: Most of the patients who developed such adverse effects did not report a family history of psychiatric disease. The frequency of psychiatric adverse effects depends on the patient’s biological sex, age, and body mass index, but not on the drug dosage. Conclusions: Based on clinical trials and case reports, the current literature presents evidence for a risk of short-term psychiatric adverse effects induced by either drug.

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Section: Discussionmentioning

confidence: 99%

Systematic Review of Psychiatric Adverse Effects Induced by Chloroquine and Hydroxychloroquine: Case Reports and Population Studies

et al. 2022

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“…They present changes in pharmacokinetics and pharmacodynamics leading to an enhanced incidence of drug toxicity and, consequently, side effects. In addition, HCQ and CQ tend to accumulate more easily in the elderly’s fat tissues due to the diminished water in their body (Altintas E., 2015; Kwak Y.T. et al, 2015.…”

Section: Discussionmentioning

confidence: 99%

“…CQ plasma concentration can reach 53% of its peak concentration 5 days after the last dose, and detectable amounts can be found even 42 months after its withdrawal (Sapp O.L., 1964) . The individuals' differences in absorption and degradation, and the consequent differences in the drug steady-state concentration may lead to the variability in the time window between the drug intake and psychiatric side effect appearance (Altintas E., 2015;Garg P. et al, 1990;Manzo C. et al, 2017;Sapp O.L., 1964) .…”

Section: • Mechanism Of How the Psychiatric Conditions May Developmentioning

confidence: 99%

Psychiatric side effects induced by chloroquine and hydroxychloroquine: a systematic review of case reports and population studies

Talarico

Chakravarty

Liu

et al. 2020

Preprint

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Chloroquine and hydroxychloroquine are commonly used drugs in the treatment of malaria as well as chronic diseases, such as rheumatoid arthritis, and systemic lupus erythematosus. Although various reports on possible psychiatric side effects of these drugs exist, the nature and extent of these effects remain poorly understood. Moreover, the relevance of these drugs in the treatment of early stages of COVID-19 necessitates a careful estimation of their side effects. Here, we provide a systematic review of the psychiatric side effects associated with chloroquine and hydroxychloroquine. We used PubMed, Scopus, and Web of Science platforms to identify relevant literature published between 1962 and 2020. Search terms included chloroquine, hydroxychloroquine, psychiatry, psychosis, depression, anxiety, bipolar disorder, delirium, and psychotic disorders. Only case reports and clinical trials were included. All studies included records of psychiatric side effects induced by either chloroquine or hydroxychloroquine or both. Both retrospective and prospective, randomized as well as non-randomized population studies were included. Overall, the psychiatric side effects are dose- and sex-independent. The most common psychiatric side effects reported are increased speech output/ excessive talking, increased psychomotor activity, irritable mood, auditory hallucinations, delusion of grandiosity, and suicide attempts, likely due to brain intoxicationbe of chloroquine or hydroxychloroquine. The symptoms can develop in a few hours to 11 weeks after drug intake and are normally reversed within a week after the drug withdrawal. We conclude that CQ and HCQ have the potential to induce psychiatric side effects. This study calls for further investigation of psychiatric symptoms induced by these drugs in the short and long term.

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“…Risk factors are better identified and are more important in clinical practice ( Table I ). However, CQ/HCQ neuropsychiatric adverse events can be possible even in the absence of any risk factor, such as type B adverse drug reaction in accordance with the Rawlins and Thompson classification [ 8 , 9 ]. No difference between older and younger patients was found, but polypharmacology and age-related impairment of organ functions can increase the risk in older ones [ 3 , 7 ].…”

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confidence: 99%

Antimalarials – are they effective and safe in rheumatic disease? Focus on the neuropsychiatric side effects

Manzo¹

2018

Reumatologia

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Neuropsychiatric manifestations are uncommon adverse events in patients with rheumatic diseases, when treated with chloroquine (CQ) or hydroxychloroquine (HCQ). This possibility is related to their ability to cross the blood-brain barrier ; in the brain, they have a tissue concentration up to10-20 times higher than the plasmatic one. A great variety of neuropsychiatric side effects was referred to CQ/HCQ; in some cases, they caused the patient' s hospitalization or death. Personal previous psychiatric symptoms, family history, female gender, alcohol intake, co-exposure with some drugs ( including low doses of glucocorticoids) , a dose >6.5 for HCQ and >3 mg/kg/day for CQ, are the most important risk factors. No difference between older and younger patients was found but polypharmacology and age-related renal impairment, can increase the risk in older ones. Differential diagnosis between pharmacological side effects and neuropsychiatric manifestations of the rheumatic disease is mandatory.

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Hydroxychloraquine-induced acute psychotic disorder in a female patient with rheumatoid arthritis: a case report

Cited by 5 publications

References 10 publications

Systematic Review of Psychiatric Adverse Effects Induced by Chloroquine and Hydroxychloroquine: Case Reports and Population Studies

Systematic Review of Psychiatric Adverse Effects Induced by Chloroquine and Hydroxychloroquine: Case Reports and Population Studies

Psychiatric side effects induced by chloroquine and hydroxychloroquine: a systematic review of case reports and population studies

Antimalarials – are they effective and safe in rheumatic disease? Focus on the neuropsychiatric side effects

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