Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Attention has once again been directed to the very uncomfortable itching following chloroquine chemotherapy of malaria in about 8% of the Nigeria population. Six typical case reports are presented. We have been able to identify three stages in the course of the itching and in the second stage, four phases have been outlined. The major implications of the pruritus are briefly discussed in respect to its effect on malaria treatment. Its possible link with more serious adverse effects and variations in drug metabolism are also mentioned. The treatment outlined is directed towards minimizing the intensity and duration of the itching reaction.
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PMID:The practical and therapeutic implications of chloroquine-induced itching in tropical Africa. 41 40

Chloroquine is considered essentially nontoxic when used for the chemosuppression of malaria, but gastrointestinal upsets, headache, blurring of vision, pruritus, and uritcaria may occur during chloroquine therapy. Recently, Bhargava et al. and Eronini and Eronini have reported the extrapyramidal syndrome (EPS) following chloroquine therapy in adults. The clinical manifestations included upward rolling of the eyeballs, retraction of neck and back, trismus with marked difficulty in speech, and coarse tremors. Observations of 4 instances of EPS in children following chloroquine therapy for malaria are reported. A 2-1/2 year old girl was admitted to the All India Institute of Medical Sciences Hospital with a 4 day history of intermittent high grade pyrexia with chills and rigors. Following treatment with oral chloroquine in the recommended therapeutic dosage, the fever responded, but the child became drowsy and developed paroxysms of involuntary movements of the tongue, torticollis, torsion dystonia of the limbs, and parosysms of tonic muscular spasms. She completely recovered spontaneously within 48 hours. The 2nd case was that of a 12-year old female brought to the hospital with a 15-day history of intermittent high grade fever with chills and rigors. The patient was started on chloroquine sulfate in the recommended therapeutic dose. After an interval of 4 days she developed coarse tremors of the hands, upward rolling of the eyeballs, episodic deviation of the angle of the mouth towards the left, and trismus. These symptoms disappeared spontaneously within 8 hours. A 6-year old girl, the 3rd case, developed episodes of opisthotonous, upward rolling of the eyeballs, protrusions of the tongue, intermittent writhing movements of the upper limbs, and drowsiness following the ingestion of 6 tablets of chloroquine sulfate for suspected diagnosis of malaria. She spontaneously recovered from EPS over a period of about 48 hours. The 4th case, a 7-year old boy, gave a history of high grade fever with chills and rigors of 1 day's duration. He developed drowsiness, tonic spasms of the neck, upward rolling of the eyeballs, and writhing contortions of all limbs about 2 hours following intravenous administration of 100 mg of chloroquine. 8 hours later an additional 100 mg chloroquine was given intravenously for the mistaken diagnosis of cerebral malaria. On examination the child was drowsy, had generalized stiffness, torticollis, and trismus. He recovered gradually over a 48-hour period without any specific therapy. The exact mechanism of production of EPS remains uncertain.
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PMID:Extrapyramidal syndrome following chloroquine therapy. 45 22

Halofantrine is an orally administered blood schizontocide which is active against both chloroquine-sensitive and chloroquine-resistant plasmodia. Dose-finding and noncomparative clinical trials have confirmed the efficacy of halofantrine in the treatment of falciparum malaria in areas of chloroquine- and sulfonamide/pyrimethamine-resistant malaria and vivax malaria. However, poor results obtained in patients who failed mefloquine prophylaxis suggest that the efficacy of halofantrine may not extend to mefloquine-resistant P. falciparum, although more studies are needed to confirm this. Data concerning halofantrine in the treatment of P. ovale and P. malariae infections are still limited. One comparative study indicates that halofantrine has an efficacy equivalent to that of mefloquine and may be better tolerated. Halofantrine is generally well tolerated in both adults and children, the most common drug-associated effects being abdominal pain, pruritus, vomiting, diarrhoea, headache and rash, although it is difficult to distinguish between disease- and treatment-related events. The development of parasite resistance to halofantrine, like other blood schizontocides, is inevitable. Poor absorption resulting in variable peak plasma halofantrine concentrations, and possible cross-resistance with mefloquine, may accelerate the emergence of resistance to halofantrine. Thus, it is of primary importance that halofantrine is used only in areas where chloroquine- and sulfonamide/pyrimethamine-resistance are established in order to preserve and sustain its efficacy. If used with care, halofantrine will provide an important treatment option for falciparum malaria, a widespread parasitic disease associated with considerable morbidity against which the number of effective drugs available is being increasingly compromised by the spread of resistance.
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PMID:Halofantrine. A review of its antimalarial activity, pharmacokinetic properties and therapeutic potential. 137 21

Chloroquine chemotherapy of malaria fever induces severe generalised pruritus in a large proportion of black Africans. In a double blind, placebo controlled, randomised, parallel group study in 28 historically chloroquine pruritus-reactor (R+) patients, with malaria, we evaluated the prophylactic and the palliative antipruritic actions of prednisolone (5 mg) or niacin (50 mg). There was a significant prophylactic effect of both drugs on the pruritogenecity of chloroquine as well as significant reduction in the area under the pruritus intensity-time curve, AUC(0-72 h) by niacin. The salutary effect both of niacin and prednisolone on chloroquine pruritogenecity resulted neither, in the mitigation of malaria parasite clearance, nor in the clinical amelioration following antimalaria therapy.
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PMID:The effects of prednisolone and niacin on chloroquine-induced pruritus in malaria. 180 57

To confirm reports that chloroquine-induced pruritus might have a negative impact on chloroquine utilization on malaria control in Dar es Salaam, a precoded questionnaire was administered to 300 malaria patients and the respondents were then followed up at their homes during the period of their malaria treatment. It was found that 45% of the study population had suffered from chloroquine-induced pruritus at some time in their life and 27% complained of it during the study. Chloroquine-induced pruritus was found to have a significant negative impact on chloroquine utilization on malaria control in Dar es Salaam, Tanzania (P less than 0.001). The defaulting rate attributable to chloroquine-induced pruritus was 64%. The high defaulting rate (91%) among the patients with chloroquine-induced pruritus is suspected to be among the factors that contribute to the emergence and spread of resistant malaria parasites in Dar es Salaam. However, studies are needed to confirm this point. Studies are also needed to determine if there may be familial predisposition to chloroquine-induced pruritus as hypothesized in this study.
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PMID:Chloroquine-induced pruritus: its impact on chloroquine utilization in malaria control in Dar es Salaam. 182 38

The incidence and nature of pruritus induced by chloroquine and halofantrine were studied in 82 patients with acute malaria and in 40 healthy subjects, using a visual analogue scale for quantitating pruritus. Results showed that the proportion of patients with acute malaria manifesting itch to halofantrine was significantly lower than the proportion manifesting itch to chloroquine. Furthermore, the intensity and duration of halofantrine-induced pruritus were significantly lower than those of chloroquine-induced pruritus. The few patients who itched to halofantrine all had a history of itching to chloroquine. The incidence and intensity of chloroquine-induced pruritus were significantly higher in patients with malaria than in healthy subjects. By contrast, there was no significant difference between malaria patients and healthy subjects as regards halofantrine-induced pruritus. These results suggest that itchers to halofantrine may constitute a small group within the population of itchers to chloroquine. Malaria infection appears to enhance chloroquine-induced pruritus but not halofantrine-induced pruritus and this may be of therapeutic importance.
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PMID:Halofantrine-induced pruritus amongst subjects who itch to chloroquine. 182 40

To evaluate the consequences of receiving human immunodeficiency virus type 1 (HIV-1)-seropositive blood, 90 HIV-1-seronegative recipients of HIV-1-seropositive blood (case patients) and 90 HIV-1-seronegative recipients of HIV-1-seronegative blood, matched for age, sex, number of transfusions, diagnosis, and severity of illness (controls), were followed for 12 months after transfusion at Mama Yemo Hospital in Kinshasa, Zaire. Of case patients and controls, 72% were children transfused for anemia caused by malaria. Of the 46 case patients case patients alive 6 months after transfusion and for whom HIV-1 serologic results were obtained, 44 (96%) had seroconverted. Significantly more case patients (47%) than controls (16%) died within 1 year after transfusion (P less than .001). In the first 3 months after transfusion, fatigue, diarrhea, fever, cough, pruritus, pallor, oral candidiasis, polyadenopathy, hepatosplenomegaly, and rhinorrhea were observed more often among seroconverters than controls (P less than .04). Six percent of case patients and no controls had developed clinical AIDS after 12 months of follow-up. These findings underscore the urgent need for appropriate HIV screening facilities in transfusion centers worldwide.
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PMID:Seroconversion rate, mortality, and clinical manifestations associated with the receipt of a human immunodeficiency virus-infected blood transfusion in Kinshasa, Zaire. 186 35

A clinical survey in Benin (Nigeria) has revealed that 393 out of 541 respondents experienced pruritus (itching) whenever they took chloroquine for malaria treatment. The reaction was always severe in 90% of the cases. Based on this experience, the pruritus-prone subjects were subsequently given antihistamine therapy either 30 min before or along with chloroquine administration (initial dose, 600 mg base oral, or 200 mg base i.m.). The success rates obtained with the following antihistamines were 49% (chlorpheniramine maleate, 4-8 mg oral), 46% (mepyramine maleate, 50-100 mg oral), and 60% (Promethazine hydrochloride, 50 mg oral or i.m.). Promethazine appears to be the most effective in the prevention of chloroquine-induced pruritus but the differences were not significant. The antihistamine was more frequently given 30 min before chloroquine, but this had no advantage over the concomitant administration of the two drugs, which may therefore be presented in one dosage form for a better treatment compliance.
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PMID:Responsiveness of chloroquine-induced pruritus to antihistamine therapy--a clinical survey. 197 Dec 76

The efficacy of chlorpheniramine in the prevention of choroquine-induced pruritus was assessed in a trial involving 132 malaria patients with a history of chloroquine-induced pruritus. Patients who gave informed consent were randomized into either placebo or treatment group. 70 were randomized into chlorpheniramine group and 62 into placebo group. Of the 70 patients put on chloroheniramine, 52 (74%) did not develop pruritus while only 15 (24.2%) of the 62 patients put on placebo did not develop pruritus. Chlorpheniramine was significantly more efficacious in preiritus prevention than placebo (X2 = 31; p less than 0.001). The protection rate of chlorpheniramine against chloroquine-induced pruritus was 67%. The number of patients who terminated treatment prematurely was significantly higher in placebo group than in piriton group. The possibility of recommending the drug into malaria treatment schedules for individuals with known history of chloroquine-induced pruritus is discussed.
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PMID:The efficacy of piriton on chloroquine-induced pruritus in patients with malaria. 204 Feb 33

Using a presumptive animal model of the pruritus produced by chloroquine or amodiaquine in patients with malaria, the ability of mono de-ethylated chloroquine, chloroquine, mono de-ethylated amodiaquine, bi-de-ethylated amodiaquine and normal saline (placebo) to be differentiated in their pruritogenic potentials were determined. The six-hour totals of the visually-monitored pruritic activity showed that the mono de-ethylated chloroquine was no more pruritogenic than placebo (normal saline) and sedated the animals, unlike the mono-de-ethylated and the bi-de-ethylated amodiaquine metabolites which retained the known pruritogenic activity of their parent compound. It is concluded that 4-aminoquinolines with a simple aliphatic side group, like chloroquine, on losing an ethyl group (de-alkylation) have a significant reduction in the pruritogenic effect, but with a more complex aromatic side group, like amodiaquine, even the loss of both ethyl groups does not appreciably decrease their pruritogenic qualities. Thus, the dog model is apparently sensitive enough to be used as a biological animal screen for pruritogenic potentials among quinoline antimalarial drug candidates, and for structure-activity relationship studies in pruritus research.
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PMID:Structure activity relationships in the pruritogenicity of chloroquine and amodiaquine metabolites in a dog model. 206 3


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