Chloroquine & MG
 

Good morning

I have lupus with some mildish features of MG (sero neg, SFEMG neg) including fatigable respiratory weakness. We are due to fly to Punta Cana in the Dominican Republic in 6 days time and I am told that I need chloroquine for malaria (apparently it must be chloroquine only for that area?) however my GP is uneasy as it is claimed to worsen MG and can drop blood counts ( my WBC is only 2.2 and my HB 79 so I haven't much spare if this does happen). I also take Hydroxychloroquine. GP asked for advice from my Rheumy who decided to take over from here but I have heard nothing and haven't been able to chase anyone.

I'm nervous, I can't find out any information online. Which is worse? Drug side effects or risking malaria without the drugs? Hoping someone can help.

Many thanks, Clare

Plaquenil can be used for malaria.

Hydroxychloroquine: MedlinePlus Drug Information

https://www.cdc.gov/malaria/resource...hloroquine.pdf

You may not need another drug if you already take this.
It may need a dosage adjustment, but it looks like your dose already is higher than the prevention dose.

Basically tell your doctor that this is HIS job to know how to find information about this.

thank you Mrs D, that's very reassuring. I think the CDC must be a US website as all NHS advice (I am in the uk) contra-indicates Hydroxychloroquine use for malaria prophylaxis due to resistance. It sounds as though I may well be ok with the hydroxy if I don't hear back from the hospital in time. My doctor has made the right moves to find out the answer for me but the hospital told her that they would manage things from here so, not surprisingly, she has left it in their capable hands . . . I, however, have only 3 working days until we go.

Thanks again. Clare

My understanding is that the "resistance" issue relates to both quinolone drugs. That was why the Lariam here in US was recommended for traveler's malaria. Then the psychotic side effects showed up since many more people were using this drug, so now that is over here.

Here is a pretty complete article:
Malaria-Medications

You could search your destination country and see which
drug is suggested for your visit.

Clare, There's also the issue that quinolone drugs can cause a MG exacerbation. If you "up the ante" and take yet another one, you could be in serious trouble. As Mrs D said, you are already having protective effects from Plaquenil.

The fact that you are vacationing in a tropical area, where both heat and humidity are factors in tanking MG, is of even greater concern. The body can't cool down in humid conditions. I hope you are prepared for that and the fact that medical care is spotty at best in the Dominican Republic (been there myself in 1996 before I was diagnosed and it was awful). Don't forget that the area is surrounded by water, which acts as an intensifier of the sun's rays.

International Medical Centre, Mexico (Playa del Carmen , Cancun), Dominican Republic (Punta Cana)

You can protect yourself in many ways from mosquitoes while there. There are nontoxic mosquito repellents and wristbands that help. The people on the island do their best with other things such as citronella candles, etc. If you are going on any tours, through the forests for example, prepare accordingly! Just those bus rides along narrow roads are enough to push MG over the edge! And I experienced that while during a downpour.

Side effects from those drugs can be permanent (such as eye damage), so think carefully before you do something that might harm you. If you have symptoms of malaria after (or during) your trip, you need to seek out help immediately. The danger with malaria is waiting for help.

CDC - Malaria - About Malaria - FAQs

I hope you have a really good trip, without incident. You may want to keep your light on while you sleep or bring some netting. Have you seen the 2 - 3 inch long roaches in the DR? :cool: Check your luggage before you leave!

:grouphug:
Annie

Thank you once again Mrs D. That link is very useful. We are directed to www.travelhealthpro.org.uk which stipulates chloroquine for the D.R. I'm fed up that I've been left in limbo, just waiting for expert advice. My hep A jab knocked me off the face of the earth and I was deemed too unwell to proceed with the Typhoid one. All in all, I'm feeling uneasy!

Thanks so much for this reply Annie. I had read that chloroquine could exacerbate MG symptoms and, just now, I'm feeling very nervous about this trip. I wish we weren't going -I'm worried about the drugs, the risk of infection, the heat, the lack of medical provision added to the ongoing lupus flare that I've had for a year or so. Or maybe even longer .... I didn't want to go from the start but, after months of resisting, I caved to the pressure from the rest of the family - I think we've all learnt a lesson from this uncertainty. We've got gallons of deet and wristbands, I hope the hotel will provide the nets in the rooms.

The roaches sound fun! We're so sheltered in the uk - the weather may be rubbish here but there are advantages!

I hope you're keeping well xx

DEET also has a MG issue. It is an acetylcholinesterase inhibitor, just as Mestinon is. Skin is porous and that can act on your body the same as Mestinon. Too much of a CI and one can have a cholinergic crisis. Hey, maybe that and the heat will cancel each other out! :eek:

DR can be a very interesting place. But you will probably need to say no to some activities. I loved the trip to Santo Domingo, but it was a very long one. No AC in the bus.

Maybe you can call the hotel and find out about netting. And then there's the flight over the Bermuda Triangle! Kidding!!!! I'm sure you'll be fine. I gave you the address of the medical center close to where you are staying. You may want to see if they have experience with MG.

I am doing my best, given the vortex of difficulties lately. Thanks for asking!

:grouphug:
Annie