Problems Related to Antimalarial Drugs

Problems Related to Antimalarial Drugs

ProblemDrug/sDifferentiation from severe malariaTreatment
VomitingChloroquine, Quinine, Mefloquine, Halofantrine, Tetracyclines, PrimaquineVomiting is even otherwise common in malaria, usually at the height of fever.Anti emetics like Domperidone and Metaclopramide. In the young, metaclopramide can cause extra- pyramidal signs, so Promethazine can be tried.
DizzinessChloroquine, Quinine, Mefloquine, HalofantrineCould be due to high fever, dehydration and postural hypotension.Usually mild; if bothersome, drugs like Cinnarazine, Betahistine etc. can be used
ItchingChloroquineAnti histamines can be tried
Pain abdomenDrug induced gastritis causes mild discomfort and very rarely abdominal crampsChloroquine, Quinine, Mefloquine, PrimaquineIn malaria, particularly falciparum, there may be acute pain over upper abdomen or right lower abdomen, mimicking acute abdominal syndromes.Drug induced pain can be managed with antacids or H2 receptor blockers.
Altered behaviour, confusion, delirium, hallucinations, etc. Drug induced alterations in behaviour and changes in the level of consciousness usually appear after 24-48 hours of starting treatment. By then the fever and parasitemia may be lower. And this can occur on treatment for any type of malaria.Chloroquine, Quinine, MefloquineThese symptoms can be due to severe falciparum infection or due to high grade fever in any type of malaria. If these problems are caused by severe infection, then peripheral blood should show falciparum infection, high degree of parasitemia and the patient may have other symptoms and signs of severe malaria viz. anemia, hyperpyrexia, jaundice etc.Watchful expectancy; if needed, tranquilizers like Haloperidol can be used.
Convulsions Some antimalarials can induce convulsions. It may also be due to hypoglycemia induced by quinine.Chloroquine, Quinine, MefloquineIn severe malaria, convulsions may be recurrent and may lead to unarousable coma.Anticonvulsants like phenobarbitone for recurrent convulsions. Mefloquine is better avoided in known epileptics.
ComaQuinine can cause hypoglycemia, which may present as coma.In cerebral malaria, coma persists even after infusion of 50% dextrose25-50% dextrose, 50-100 ml intravenously
HypoglycemiaQuinineIn severe falciparum malaria, especially in pregnancy and children, hypoglycemia can occur even without quinine therapy25-50% dextrose, 50-100 ml intravenously
AnemiaPrimaquine: It can cause massive hemolysis in patients with Glucose 6-phosphate dehydrogenase deficiencyAnemia is a common feature in malaria, especially in children.Usually self-limiting; withdraw the drug; blood or packed cell transfusion if needed.
JaundicePrimaquine may cause hemolytic jaundice in patients with Glucose 6-phosphate dehydrogenase deficiencySevere malaria can cause hemolytic jaundice, or rarely malarial hepatitisWithdraw the drug
HemoglobinuriaPrimaquine (same group as above)
Fever Continuing even after improvement in general condition and significant reduction in parasitemia.Artemisinin derivativesIn cases of resistant malaria, with the continuation of fever, the general condition deteriorates and parasitemia increases.Self-limiting, disappears after the drug is stopped.

 © ©BS Kakkilaya | Last Updated: Mar 10, 2015

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