From the Research
For a patient with a fever of 39.3°C (102.7°F) who is taking hydroxychloroquine, the management should focus on both treating the fever and investigating its cause, with the most recent and highest quality study suggesting careful monitoring and consideration of potential adverse effects 1. The patient should start with acetaminophen (paracetamol) at a dose of 650-1000 mg every 6 hours (not exceeding 4000 mg daily) or ibuprofen 400-600 mg every 6-8 hours with food (if not contraindicated), as these are common antipyretic measures. Some key points to consider in management include:
- Ensuring adequate hydration with at least 2-3 liters of fluid daily to help reduce fever and support overall health.
- The fever requires prompt evaluation as it may represent an infection, drug reaction to hydroxychloroquine, or an underlying condition related to why the patient is taking hydroxychloroquine (such as autoimmune disease flare) 2.
- Do not discontinue hydroxychloroquine without medical consultation, as abrupt cessation could worsen underlying conditions, and there is evidence suggesting its potential benefits in certain cases 3.
- Physical cooling measures like lightweight clothing and tepid sponging can provide additional comfort.
- If the fever persists beyond 48-72 hours despite antipyretics, is accompanied by severe symptoms (confusion, extreme lethargy, difficulty breathing), or if the patient has compromised immunity, seek immediate medical attention, considering the potential for severe adverse effects as noted in the literature 4. Fever reduction is important not only for comfort but also to decrease metabolic demands and cardiovascular strain, particularly in patients with underlying health conditions. Given the potential for hydroxychloroquine to have both beneficial and adverse effects, careful consideration and monitoring are essential in managing a patient with fever who is taking this medication 1.