Aralen
Aralen
[ar´ah-len]chloroquine
(klor-oh-kwin) chloroquine,Aralen
(trade name)Classification
Therapeutic: antimalarialsIndications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (antimalarial activity)
| ROUTE | ONSET | PEAK | DURATION |
| PO | rapid | 1–2 hr | days–wks |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- seizures (life-threatening)
- anxiety
- agitation
- confusion
- delirium
- depression
- hallucinations
- headache
- insomnia
- personality changes
- polyneuritis
- psychosis
Ear, Eye, Nose, Throat
- corneal opacities (reversible)
- hearing impairment
- retinopathy
- tinnitus
- visual disturbances
Cardiovascular
- cardiomyopathy
- ECG changes (T-wave abnormalities, QRS prolongation)
- hypotension
Gastrointestinal
- abdominal cramps
- anorexia
- diarrhea
- hepatitis
- ↑ liver enzymes
- nausea
- vomiting
Dermatologic
- stevens-johnson syndrome (life-threatening)
- toxic epidermal necrolysis (life-threatening)
- alopecia
- dermatoses
- photosensitivity
- pigmentary changes
- pruritus
- skin eruptions
- urticaria
Hematologic
- agranulocytosis (life-threatening)
- aplastic anemia (life-threatening)
- leukopenia (life-threatening)
- thrombocytopenia
Neurologic
- neuromyopathy
- peripheral neuritis
- weakness
Interactions
Drug-Drug interaction
Antacids may ↓ absorption (separate administration of these agents by at least 4 hr).Blood levels may be ↑ by cimetidine,fluconazole,ketoconazole,clarithromycin,erythromycin,fluoxetine,nefazodone,paroxetine,protease inhibitors,quinidine,ritonavir, and verapamil (concurrent use with cimetidine, should be avoided).May ↓ absorption of ampicillin (separate administration of these agents by at least 2 hr).May ↑ blood levels of cyclosporine,fluoxetine,lidocaine,mirtazapine,nefazodone,paroxetine,risperidone,ritonavir,thioridazine,tricyclic antidepressants, and venlafaxine.Blood levels may be ↓ by carbamazepine,nevirapine,phenobarbital,phenytoin, and rifampin.May ↑ the risk of hepatotoxicity when administered with other hepatotoxic agents.Urinary acidifiers may ↑ renal excretion and ↓ effectiveness.Concurrent use with mefloquine may ↑ risk of seizures.Foods that acidify urine (see ) may ↑ excretion and ↓ effectiveness.Route/Dosage
Doses below expressed as chloroquine base: 1 mg of chloroquine base = 1.67 mg chloroquine phosphate or 1.25 mg chloroquine hydrochlorideSuppression/Prophylaxis of MalariaAvailability
Chloroquine Phosphate
Nursing implications
Nursing assessment
- Determine baseline for future reference that includes current symptoms of disease prior to administration.
- Assess deep tendon reflexes periodically to determine muscle weakness. If weakness occurs, discontinue therapy.
- Discontinue therapy immediately if hearing impairment develops.
- Perform ophthalmologic exam initially and periodically during therapy; discontinue therapy immediately if visual disturbances develop.
- Observe for development of rash. Discontinue chloroquine at the first sign of skin reactions. Serious adverse reactions such as Stevens-Johnson syndrome or toxic epidermal necrolysis preclude further use.
- Malaria: Assess patient for improvement in signs and symptoms of condition daily throughout therapy.
- Rheumatoid Arthritis/Systemic Lupus Erythematosus: Assess degree of joint pain and limitation of motion monthly.
- Lab Test Considerations: Monitor CBC periodically throughout therapy. May cause decreased WBC and platelet counts.
- Monitor liver function tests periodically during therapy.
Potential Nursing Diagnoses
Risk for infection (Indications)Chronic pain (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
Implementation
- For malaria suppression/prophylaxis, chloroquine therapy should be started 2 wk prior to potential exposures and continued for 8 wk after leaving the area.
- Oral: Administer with meals to minimize GI distress.
Patient/Family Teaching
- Instruct patient to take medication exactly as directed and continue full course of therapy, even if feeling better. Missed doses should be taken as soon as remembered, except with regimens requiring doses more than once a day, for which missed doses should be taken within 1 hr or omitted. Do not double doses.
- Review methods of minimizing exposure to mosquitoes with patients receiving chloroquine prophylactically (use insect repellent, wear long-sleeved shirt and long trousers, use screen or netting).
- Advise patients to avoid use of alcohol while taking chloroquine.
- Caution patient to keep chloroquine out of the reach of children; fatalities have occurred with ingestion of 3 or 4 tablets.
- Explain need for periodic ophthalmic exams for patients on prolonged high-dose therapy. Advise patient that the risk of ocular damage may be decreased by the use of dark glasses in bright light. Protective clothing and sunscreen should also be used to reduce risk of dermatoses.
- Advise patient to notify health care professional promptly if sore throat, fever, unusual bleeding or bruising, blurred vision, difficulty reading, visual changes, ringing in the ears, difficulty hearing, mental changes, or muscle weakness occurs or if diarrhea, anorexia, nausea, stomach pain, vomiting, or rash becomes pronounced or bothersome. Most adverse reactions are dose related.
- Advise female patient to notify health care professional of pregnancy is planned or suspected, or if breastfeeding.
- Rheumatoid Arthritis/Systemic Lupus Erythematosus: Instruct patient to contact health care professional if no improvement is noticed within a few days. Treatment may require up to 6 mo for full benefit.
Evaluation/Desired Outcomes
- Prevention of or improvement in signs and symptoms of malaria.
- Regression of extraintestinal amebic disease.
- Decrease in the symptoms and progression of rheumatoid arthritis and systemic lupus erythematosus.