Pharmacology and toxicology
Chloroquine, an antimalarial drug from the 4-aminochinoline group, is a rapidly-acting blood schizonticide, destroying the asexual blood forms of all Plasmodium species. Chloroquine resistance is common in many malaria-endemic regions, This resistance mainly concerns the pathogenic parasite of the severe and often deadly progressing malaria tropica (pathogen: Plasmodium falciparum). However, resistance against chloroquine has also been observed in Plasmodium vivax, the pathogenic parasite of the less severely progressing malaria tertiana.
Chloroquine is neither embryo- nor fetotoxic when used in the usual dosage for malaria prophylaxis, and when used for the treatment of the malarial infection in a 3-day course (Philips-Howard 1996). A study on the use of chloroquine in a 3-day course for the treatment of Plasmodium vivax infection during the first trimester of pregnancy confirms these findings (McGready 2002).
Damage to the fetal retina and inner ear has been linked to chloroquine therapy in pregnancy; in these cases, chloroquine was used daily in high doses on a long-term basis (Hart 1964). Such long-term, high-dose therapy may be used for other indications -for instance, in chronic inflammatory diseases. However, small series of patients taking large doses of (hydroxy)chtoroquine during pregnancy for treatment of systemic lupus erythematosus did not show an increased risk of congenital malformations or other adverse effects (Parke 1996; see also Chapter 2.1).
Recommendation. Chloroquine is the drug of choice for prophylaxis and treatment of malaria during all phases of pregnancy if the parasite is sensitive, and if appropriate for the type and severity of the malarial infection. If chloroquine resistance of the parasite is likely or has been demonstrated, other drugs must be used for the prophylaxis and treatment of malaria. It is important to keep informed of current recommendations for the region in question.
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