Antimalarials

A group of drugs effective against plasmodia, which has also found broad (indispensable) use in the treatment of inflammatory diseases.

General questions about treatment with antimalarials

When can an effect be expected?

• Most patients notice an improvement only after 3 to 4 months. In a few patients it can also take up to ½ years before an effect is felt. In rheumatism patients, in patients with lupus erythematosus morning stiffness and tiredness decrease.

How is the treatment with anti-malarial drugs carried out?

• Antimalarial drugs are only available in tablet form. In general, the dose depends on your body weight, but also on the nature of your disease. Your doctor will explain this to you in more detail.

Can antimalarials be combined with other medicines?

• Yes, the anti-malarials can be combined with other medicines very well. Especially at the beginning of the treatment, when their effect has not yet been fully achieved, the antimalarial therapy can be supplemented with non-steroidal anti-rheumatic drugs or with preparations containing cortisone in the case of rheumatic diseases. With these combinations the initial phase can be bridged well.

How long must a treatment be carried out?

• Treatment with antimalarial drugs is a long-term therapy, lasting many months, sometimes years. Important: It will only be successful if you take the medication regularly.

Does it happen that the treatment with anti-malarial drugs is not effective or not sufficient?

• This question can certainly only be answered after 4-6 months. If the treatment effect is not sufficient after ½ year, your doctor will either discontinue the treatment or supplement it with another drug. How this is done, however, depends very much on the nature of your illness.

What side effects can occur?

• Basically it can be said that there is no effective medication without any side effects. However, most of the side effects of antimalarial therapy are harmless. Nausea, vomiting, sometimes headaches, tiredness and dizziness can occur in some patients. These symptoms are most noticeable in the first weeks of treatment.

Do antimalarial drugs affect the eyes?

• In the first few days, vision problems such as blurred vision, sensitivity to light or changes in colour vision can rarely occur. These symptoms disappear after a short time. They are not dangerous. Possibly they hinder driving a car.

Are there any dangerous side effects on the eyes?

• Before starting and during the treatment with anti-malaria drugs you must have regular check-ups by an ophthalmologist. During the treatment, deposits in the cornea, very rarely retinal changes may occur. They depend on the dose. These changes are easy to detect. The dose is then adjusted. In very rare cases, you may have to stop taking the medication. The cause of the previously feared "irreversible retinopathy" (shooting target maculopathy) was due to an overdose.

Pregnancy and antimalarials.

• Antimalarials are used without known risks in pregnancy and lactation. After consultation with your doctor, the therapy can therefore be continued during pregnancy and breastfeeding if necessary.

Kidney diseases and antimalarials:

• In advanced kidney disease (renal insufficiency -GFR < 30 ml/min) the daily dose should be reduced accordingly. In dialysis patients the dose is reduced to 15% of the normal dose.

Should smoking be stopped during the treatment?

• Smoking and antimalarials: In our opinion and in the opinion of many doctors, smoking reduces the effect of the antimalarials. For all patients with e.g. SLE, nicotine withdrawal should be observed.

1. Ochsendorf FR (2010) Use of antimalarials in dermatology. JJDG8: 929-845

Substances and spectra of action of antimalarials

1. Ochsendorf FR (2010) Use of antimalarials in dermatology. JDDG 8: 829-845
2. Mittal L et al (2018) Antimalarial drug toxicities in patients with cutaneous lupus and dermatomyositis: A retrospective cohort study. J Am Acad Dermatol 78:100-106.