Chloroquine and

Quinacrine (49) is an acridine that was used extensively from the mid-1920s to the end of World War 11. It acts much like chloroquine and is reasonably effective. Because it causes the skin to turn yellow and, in high doses, causes yellow vision, the dmg is no longer in use as an antimalarial. Pyronaridine (77), a 1-azaacridine developed in China, appears to be effective against mefloquine-resistant, but not entirely against chloroquine-resistant, strains of P falciparum. 

Chloroquine is contraindicated in patients with known hypersensitivity. It is a good idea to use chloroquine cautiously in patients with hepatic disease or bone marrow depression and during pregnancy. Children are very sensitive to chloroquine, and the drug should be used with extreme caution in children. 

Blackie, M.A.L., Beagley, P., Chibale, K., Clarkson, C., Moss, J.R. and Smith, P.J. (2003) Synthesis and antimalarial activity in vitro of new heterobimetallic complexes Rh and Au derivatives of chloroquine and a series of ferrocenyl-4-amino-7-chloroquinolines. Journal of Organometallic Chemistry, 688(1-2), 144-152. 

Following treatment of falciparum malaria, TW has remained well for 2 months. However, 2 days ago, he started developing fever and chills, nausea, and abdominal pain. When seen in the emergency department he has a fever of 38.4°C and complains of severe headache. Examinations of a thick and thin blood smear of the patient s blood identified P. vivax infection. TW received a course of chloroquine and primaquine. In a follow-up 2 weeks later, a repeat blood smear was negative for parasites and the patient was asymptomatic. 

Malaria, a tropical disease caused by protozoan parasites of the genus Plasmodium, has been a major concern for centuries and has now extended to a great deal of the world s population, killing every year 1-2 million people. Different medicines are in use to cure or to prevent malaria. The classical natural medicine quinine was soon replenished with synthetic compounds such as primaquine, chloroquine and mefloquine. However, a major problem is still an increasing resistance towards these compounds. 

Plasmodium (P.) falciparum, responsible for the most dangerous form of malaria, is particularly prone to develop drug resistance. The incidence of resistant strains rises with increasing frequency of drug use. Resistance has been reported for chloroquine and also for the combination pyrimethamine/ sulfadoxine. 

Chloroquine is the drug of choice for preventing and treating acute forms of malaria caused by P. vivax, P. malariae, P ovale, as well as sensitive forms of P. falciparum. The mechanism of its action is not completely clear, although there are several hypotheses explaining its antimalarial activity. Chloroquine and its analogs inhibit synthesis of nucleic acids of the parasite by affecting the matrix function of DNA. This happens by preliminary... 

Amodiaquin is also a structural analog of chloroquine and hydroxychloroquine, and it does not express any vital differences in terms of activity. Therefore it is used less often than the drugs described above. Synonyms of this drug are flavoquine and camoquin. 

Malaria (doxycycline only) Prophylaxis of malaria due to Plasmodium falciparum in short-term travelers (less than 4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strains. 

Malaria is the cause for approximately 20% of child deaths in Africa and for more than 1 million deaths around the world each year. The appearance and spread of drug resistance of the Plasmodium falciparum parasites to common antimalarial drugs, such as chloroquine and hydroxychloroquine, have posed the urgent challenge of developing effective, safe and affordable antimalarial drugs. 

VI.a.2.1. AminoquinoUnes. The aminoquinolines currently used as antimalarials include the 4-amino-quinolines chloroquine and mefloquine and the 8-aminoquinoline primaquine. 

VI.a.2.3. Quinine alkaloids. The quinine alkaloids include quinine and quinidine. Quinidine, the dextrorotatory diastereoisomer of quinine, is mainly used for the parenteral treatment of cardiac arrhythmias but it can be an alternative antimalarial in regions where Plasmodium falciparum is resistant to both chloroquine and antifolate-sulfonamide combinations. 

Knowledge of local resistance patterns is important to determine the treatment regimen. There is increasing chloroquine and pyrimethamine-sulfado-xine (Fansidar) resistance in Africa and in some areas at the border of Thailand there is resistance for almost all antimalarial drugs including halofantrine, mefloquine and quinine. In these areas only the artemisinin derivatives (artemether, arteether, arte-sunate, dihydroartemisinin) are effective. 

Hydroxychloroquine is approved for the treatment of both systemic and cutaneous lupus erythematosus. Both chloroquine and quinacrine (Atabrine) are also effective in this skin disease. Low-dose chloroquine is used for the therapy of porphyria cutanea tarda in patients in whom phlebotomy has failed or is contraindicated. Other skin diseases in which the drugs are useful (after sunscreens and avoidance of sun exposure) include polymorphous light eruption and solar urticaria. 

Fluoroquinolones The story of fluoroquinolones began in the 1950s with the discovery of the antibacterial properties of 7-chloroquinolone, a side product of the preparation of chloroquin and glafenin. Further research led to the... 

It is derivative of artemisinin. These agents produce a more rapid clearance of parasites than quinine, chloroquine and mefloquine in treatment of severe... 

Chloroquine and hydroxychloroquine are used mainly in malaria (see Chapter 52) and in the rheumatic diseases. The mechanism of the antiinflammatory action of these drugs in rheumatic diseases is unclear. The following mechanisms have been proposed suppression of T-lymphocyte responses to mitogens, decreased leukocyte chemotaxis, stabilization of lysosomal enzymes, inhibition of DNA and RNA synthesis, and the trapping of free radicals. 

Figure 5.1 The structures of chloroquine and chlorphen-termine, two CADs showing the hydrophilic and hydrophobic regions. Abbreviation CAD, cationic amphipathic drug.

Chloroquine and related antimalarials are effective in rheumatoid arthritis and lupus erythematosus, but their mode of action is not known. The anthelmintic drug levamisole (186) is also effective but adverse effects limit its use. 

Several drugs (for example amiodarone, androgens, glucocorticoids, phenytoin, and salicylates) interfere with the transport or metabolism of thyroid hormones and thereby alter thyroid function tests. These have been reviewed (90). In patients taking levothyroxine serum TSH rises after treatment with sertraline (91) and antimalarial prophylaxis with chloroquine and proguanil... 

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