What is the association between fever and hydroxychloroquine (Plaquenil) (antimalarial medication)?

From the Guidelines

Fever is not a recommended indication for the use of hydroxychloroquine, and its use is not supported by recent evidence for the treatment of COVID-19 or other conditions where fever is a primary symptom. The management of fever in patients taking hydroxychloroquine should focus on identifying and treating the underlying cause, which may involve discontinuing hydroxychloroquine if it is suspected to be the cause of the fever. According to the European Respiratory Journal study 1, hydroxychloroquine has been shown to have no significant benefit in reducing mortality or improving clinical outcomes in patients with COVID-19, and its use is associated with an increased risk of adverse events, including cardiac toxicity.

In cases where hydroxychloroquine is being used for conditions such as malaria or chronic Q fever, the management of fever should be guided by established treatment protocols, such as those recommended by the CDC 1 and 1. For example, in the treatment of chronic Q fever, a combination regimen of doxycycline and hydroxychloroquine may be used, with careful monitoring of serologic and clinical responses.

Key considerations in the management of fever in patients taking hydroxychloroquine include:

• Identifying and treating the underlying cause of the fever
• Discontinuing hydroxychloroquine if it is suspected to be the cause of the fever
• Using established treatment protocols for specific conditions, such as malaria or chronic Q fever
• Monitoring for adverse events, including cardiac toxicity and retinal toxicity
• Providing supportive care, including antipyretics and hydration, as needed.

It is essential to prioritize the patient's safety and well-being, and to seek immediate medical attention if the fever is severe or accompanied by other concerning symptoms.

From the FDA Drug Label

Advise patients to seek medical attention promptly if they experience signs and symptoms of serious skin reactions such as blisters on the skin, eyes, lips or in the mouth, itching or burning, with or without fever The answer to the question about fever in hydroxychloroquine is that fever can be a symptom of a serious skin reaction, but it is not a direct or common side effect of hydroxychloroquine itself, according to the provided drug label 2.

From the Research

Fever in Hydroxychloroquine

• The provided studies do not directly address the topic of fever in hydroxychloroquine. However, some studies mention the use of hydroxychloroquine in the treatment of COVID-19, which can cause fever as a symptom.
• A study published in 2021 3 found that hydroxychloroquine probably results in little to no difference in the proportion of people having negative PCR for SARS-CoV-2 on respiratory samples at day 14 from enrolment.
• Another study published in 2020 4 found that hydroxychloroquine is consistently effective against COVID-19 when provided early in the outpatient setting, and it is overall effective against COVID-19.
• A review published in 2021 5 found that there is insufficient evidence about the efficacy and safety of hydroxychloroquine in COVID-19, and its use should be discouraged outside clinical trials under strict medical supervision.
• A study published in 2020 6 reviewed the history and mechanism of actions of hydroxychloroquine and chloroquine, and their potential use in the treatment of COVID-19.

Side Effects of Hydroxychloroquine

• The studies mention that hydroxychloroquine can cause adverse events, including QT-interval prolongation on electrocardiogram 3.
• A study published in 2021 3 found that hydroxychloroquine probably results in an almost three-fold increased risk of adverse events.
• A review published in 2021 5 found that hydroxychloroquine is generally well-tolerated, although severe life-threatening adverse effects, including cardiomyopathy and conduction defects, have been reported.

Efficacy of Hydroxychloroquine in COVID-19

• A study published in 2021 3 found that hydroxychloroquine makes little or no difference to death due to any cause, and probably results in little to no difference in progression to mechanical ventilation.
• A study published in 2020 4 found that hydroxychloroquine is consistently effective against COVID-19 when provided early in the outpatient setting.
• A review published in 2021 5 found that there is insufficient evidence about the efficacy and safety of hydroxychloroquine in COVID-19.