Question:
I was
prescribed and took anti-malarial (eg Nivaquine) tablets for 9 years
and discovered that it had affected my eyes.
It was
diagnosed 3 years ago and I consulted an Ophthalmologist/eye surgeon
who advised me to stop taking the tablets immediately.
I had
various tests done and was injected with a dye to see the extent of
the damage.
I have
mostly central vision problems and blind spots that are permanent.
I went
back the following year and repeated the tests and there was some
improvement in the one eye and some degradation to the other eye.
I was
basically told that the damage was permanent and could get worse or
could improve slightly.
I never
went for the tests last year.
I wanted
to know if I should go back this year and do the tests again or just
deal with it and continue to wait for my eyes/vision to stabilize.
I know
the vision has worsened and I need new prescription for glasses and
contact lenses.
Should
I go back or wait longer?
The second
question is that the anti-malarial medication helped me with body
aches and pains and since I have been off the medication the pain
is much worse, and I live on pain killers and anti-inflammatories.
Is there
any other medication that I can take in substitution of the anti-malarials
that could help my situation?
Thanks
and regards,
Lee
Answer:
Dear
Lee,
You should
go back this year and do the tests again
You shouldn't
wait longer.
Nivaquine
has the potential to cause serious medical complications. In rare
cases of long-term use, Nivaquine sometimes damages the retina or
causes permanent deafness.
Some
patients experience convulsions, delusions or hallucinations while
taking Nivaquine.
Infrequently,
Nivaquine disrupts cardiovascular electrical activity or causes sudden,
dangerous drops in blood pressure levels. Inflammation or liver damage
to also is possible while taking Nivaquine.
Hydroxychloroquine
(Plaquenil®) is sometimes used as an alternative for chloroquine
(Nivaquine®), but one of the most serious side effects is a toxicity
in the eye (generally with chronic use), and requires regular screening
even when symptom-free.
Toxicity
from hydroxychloroquine may be seen in two distinct areas of the eye,
the cornea, and the macula. The cornea may become affected (relatively
commonly) by an innocuous vortex keratopathy and is characterized
by whorl-like corneal epithelial deposits.
These
changes bear no relationship to dosage and are usually reversible
on cessation of hydroxychloroquine.
The macular
changes are potentially serious and are related to dosage and length
of time taking hydroxychloroquine.
Established
maculopathy is characterized by moderate reduction of visual acuity
and an obvious "bulls eye" macularlesion.
End stage
maculopathy is characterized by severe reduction in visual acuity
and severe atrophy of the retinal pigment epithelium.
The popular
herbal antimalarial, Extract of Cryptolepis sanguinolenta, is potently
cytotoxic.
Artemisinin
(an extract from the plant artemisia), a Chinese and Southeast Asian
herbal treatment for malaria, proved to be highly effective during
an epidemic of malaria in Vietnam during the early 1990s when it reportedly
cut the death rate by 97%.
In America,
the new Global Fund for AIDS, Tuberculosis and Malaria has now given
11 countries funding to purchase this herbal remedy and told another34
countries to drop their applications for older drugs, including chloroquine
and sulfadoxine-pyrimethamine, and switch to artemisinin.
Lariam
another drug to prevent malaria can cause psychiatric problem.
The medication
Doxycycline Hyclate is also used to prevent malaria but blurred vision
side effects are associated with Doxycycline Hyclate.
