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)

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

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

Chloroquine prophylaxis for malaria was available free of charge to pregnant women in Saradidi, Kenya. The drug was supplied by village health helpers (VHH's). However, only 29.1% of 357 pregnant women seen in antenatal clinics from 1983 to 1984 were on chemoprophylaxis. One hundred and seven pregnant women not using antimalarial chemoprophylaxis from 22 villages were interviewed in June 1984 to determine the reasons. Age (mean 26.9 years), parity (mean 4.5 children), occupation (96.3% subsistence farmers and housewives) and education (median five to seven years) of the 107 respondents were similar to other women in the area. Previous pregnancies had occurred in 92 women; for 15 this was the first pregnancy. The last pregnancy had resulted in a live birth for 81 (88.0%), a stillbirth for nine (9.8%) and a miscarriage for two (2.2%); 21 (22.8%) of the 92 had experienced a miscarriage or stillbirth at some time (15 once, five twice and one woman four times). Malaria was the most frequent mentioned (28.6% of 21 women) cause of the last stillbirth or abortion. The major reason for not taking chemoprophylaxis was lack of awareness that the service was available (53.3% of 107 women). Other reasons were fear of chloroquine-induced itching (10.3%), the VHH had no drug (8.4%), the VHH had not advised her to take drug (8.4%), the woman was 'not sick' (7.5%), the woman was 'lazy' (6.5%), she had not been advised by clinic so was afraid to mix medicines (3.7%) and chloroquine was 'bad for pregnancy' (1.9%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Malaria chemoprophylaxis to pregnant women provided by community health workers in Saradidi, Kenya. I. Reasons for non-acceptance. 368 40

1. Chloroquine was given by a single intravenous injection to rabbits and to two groups of patients. The concentrations of the drug and its more polar metabolites in plasma and tissue were measured by a fluorometric method.2. The concentrations of chloroquine in rabbit liver exceeded those in skin and these in turn exceeded those in plasma. Chloroquine concentrations in rabbit skin were fairly steady between 24 and 72 h after injection. Chloroquine was still present in skin 30 days after the injection. Metabolites of chloroquine were present in plasma, skin and liver.3. Skin was taken from patients 48 h after an intravenous dose of chloroquine (1.25 mg/kg). Skin from patients prone to chloroquine-induced pruritus contained higher concentrations of chloroquine (P<0.01) and lower concentrations of metabolites (P<0.01) than skin from other patients.4. It is suggested that increased liability to chloroquine-induced pruritus may be associated with a lower rate of chloroquine metabolism.
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PMID:Chloroquine concentrations in the skin of rabbits and man. 515 2

A total of 1059 persons from 14 different locations in Ibadan (the most populous city in tropical Africa) were interviewed to determine whether they had had itch reaction with each of the 12 4-aminoquinoline preparations (one amodiaquine hydrochloride, 11 chloroquine). The various trade and pharmacological names are listed in a table. Respondents were asked for what purpose the listed drugs were used: treatment of an attack of malaria fever; prevention of malaria; and other conditions or illnesses. The respondents were also asked how often each subject had an attack of malaria: monthly, every 3 months, every 6 months, once a year, once every 2-3 years, less often than this, never. Inquiry was made regarding details of the itch reaction since there was particular interest in the pruritus which, judging from previous studies, constitutes the 1 reaction most likely to make 4-aminoquinolines unpopular. Chloroquine sulphate tablets, the 8th most popular preparation, was the 6th on the list of itching incidence. There appeared to be no difference in the incidence of itching after chloroquine sulphate injection. Avloclor tablets, chloroquine phosphate injection tablets and Malarex and Aralen tablets gave a comparatively low incidence of itch reaction--3.4% and 1.4% respectively within the population studied. The incidence of itching after these 4-aminoquinoline preparations may also be estimated in the population sampled by finding the mean percentage of the subjects who itch within those who admitted taking each preparation mentioned in the questionnaire. The corrected percentage incidence gave an estimated mean of 28% compared with a mean incidence of 11% when projected to the whole population sampled. Most of the people (90%) used the 4-aminoquinoline antimalarials to treat an attack of malaria fever; 23% take them for prophylaxis and 7% in the population used the drugs for nonmalarial ailments. The misuse of the drugs for nonmalarial ailments may be related to their potency in treating malaria. In sum, the itch reaction failed to conform to a simple clinical pattern.
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PMID:Use and misuse of 4-aminoquinoline antimalarials in tropical Africa and re-examination of itch reaction to these drugs. 726 16

Knowledge, perception and utilisation of malaria prophylaxis were assessed among pregnant women attending antenatal care clinic in Dar es Salaam, Tanzania. Of the 301 women interviewed, 71.1% reported having used chloroquine prophylaxis while 28.9% did not. Women with high knowledge of malaria were more likely to use malaria prophylaxis than those with low knowledge. However, there was no significant association between knowledge of malaria and perceived effectiveness of the various methods of malaria control. Chloroquine side effects and perceived lack of protective effect against malaria were mentioned as causes of failure to use chloroquine prophylaxis. Fear of chloroquine-induced pruritus accounted for the largest proportion (49.4%) of women who reported having failed to use chloroquine prophylaxis. Occurrence of malaria episodes was reported to be similar among users and non-users of malaria prophylaxis probably due to inconsistent use of malaria prophylaxis and reduced chloroquine sensitivity of malaria parasites. It is suggested that, in addition to chemoprophylaxis, pregnant women should be encouraged to use bednets in combination with mosquito repellents throughout the course of pregnancy.
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PMID:Perception and utilisation of malaria prophylaxis among pregnant women in Dar es Salaam, Tanzania. 749 25

Chlorpheniramine, a histamine H1 receptor antagonist, reverse chloroquine resistance in Plasmodium falciparum in vitro. However, the clinical significance of this remains unclear. We have evaluated the efficacy of chloroquine and a chloroquine-chlorpheniramine combination in 112 consecutive children with acute symptomatic uncomplicated falciparum malaria. There was no significant difference in the parasite and fever clearance times in the 2 treatment groups. However, the proportion of patients in whom parasitaemia increased 24 h after commencement of treatment was significantly higher in the chloroquine group than in the chloroquine-chlorpheniramine group (28.5% vs. 8.3%, chi 2 = 6.61, P < 0.01). There was also a higher proportion of children with RII and RIII responses to treatment in the chloroquine than in the chloroquine-chlorpheniramine group but the difference was not statistically significant. The cure rate on day 14 was higher in the chloroquine-chlorpheniramine group than in the chloroquine group. Chloroquine and its combination with chlorpheniramine were well tolerated, the only prominent adverse effect being pruritus, with equal incidence in both groups. Chlorpheniramine reversed chloroquine resistance in vitro in a similar manner to verapamil in isolates of P. falciparum obtained from the patients. Failure of a response in vivo to chloroquine correlated with resistance in vitro in patients treated with this drug. In contrast, all but one patient with isolates which were chloroquine resistant in vitro were successfully treated with chloroquine-chlorpheniramine combination. These data suggest the enhanced efficacy of chloroquine-chlorpheniramine combination in treating acute uncomplicated P. falciparum infection in children from an endemic area of Nigeria.
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PMID:Enhanced efficacy of chloroquine-chlorpheniramine combination in acute uncomplicated falciparum malaria in children. 950 91

Chloroquine is commonly used in the chemotherapy of malaria fever, and as an antiinflammatory disease-modifying agent in patients with rheumatoid arthritis or systemic lupus erythematosus. Administration of chloroquine (20.0 mg/kg IP) significantly (p < 0.05) increased the frequency of body scratching in rats to 29.5+/-9 in 30 min, compared to saline control animals (6.5+/-2/30 min). Morphine, a mu-opiate receptor agonist (1.0 mg/kg IP), potentiated the chloroquine-induced rat body scratching to 40+/-6.6, while the mu-opiate receptor antagonist, naltrexone (0.25 mg/kg, IP, given 15 min prior) blocked the chloroquine induced body scratching to 4.5+/-2 (p < 0.05 ANOVA). In addition, the frequency of chloroquine (20.0 mg/kg IP)-induced body scratching was significantly reduced to 9.1+/-3 in 30 min in rats rendered tolerant to morphine (p < 0.05 ANOVA) compared to the scratching frequency of 40+/-6.6 in morphine-naive rats. These suggests an involvement of mu-opioid receptors and/or endogenous opioid peptides in chloroquine induced body scratching in rats. Promethazine, a histamine-receptor antagonist (1.0 mg/kg IP, given 15 min prior to chloroquine) and the corticosteroid, dexamethasone (1.0 mg/kg, IP, given 15 min prior) separately and significantly (p < 0.01) inhibited the chloroquine-induced scratching in rats, in a similar manner to clinical studies in malaria. Collectively, the novel results implicate opioidergic mechanisms, and confirm the efficacy of antihistamine and corticosteroids in chloroquine body scratching in rats. It also strongly suggests that the chloroquine-induced body-scratching behavior in the rat may be a useful experimental model for chloroquine-induced pruritus in humans.
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PMID:Mechanisms of chloroquine-induced body-scratching behavior in rats: evidence of involvement of endogenous opioid peptides. 1067 87

Chloroquine-induced itch in black-skinned African malaria patients is common and frequently leads to poor compliance or treatment defaulting.To assess the frequency and severity of chloroquine-induced pruritus in an Asian population, we reviewed case records of 1189 Plasmodium vivax malaria patients treated with chloroquine (25 mg/kg over 3 days) at the Bangkok Hospital for Tropical Diseases from 1992 through 1997. The majority of patients were Thais or ethnic Burmese (light brown skin), referred from the western border of Thailand. Overall, there were 23 patients (1.9%) with complaints of pruritus during chloroquine therapy. Of these, 12 (52%) had palm and sole involvement, eight (35%) had generalized pruritus including the palms and soles, and three (13%) had palm itching only. One patient developed pruritus on the palms and soles on two consecutive admissions. The pruritus did not interfere with daily activity, was reduced in intensity by anti-histamine therapy, and did not affect the patient's willingness to complete the chloroquine regimen. Therapeutic responses in the 23 patients with chloroquine itch was similar to those without itch. Among the itch patients, there was no association with gender or level of parasitaemias. Our findings indicate that the frequency of chloroquine-induced pruritus in Asian patients treated with chloroquine for P. vivax malaria is low in comparison with black-skinned Africans.This may be related to pharmacogenetic factors, the infective Plasmodium species, drug metabolism or drug-parasite interactions, or a lower affinity of chloroquine for less pigmented skin.
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PMID:Frequency of pruritus in Plasmodium vivax malaria patients treated with chloroquine in Thailand. 1107 53


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