In the study of Ruzicka et al. adverse events were described in 17 of 30 patients taking hydroxychloroquine.10 Symptoms included dry skin (n = 8), itching (n = 5) and gastrointestinal disturbance (n = 5). The most frequent side-effects described by Kraak et al. were gastrointestinal (eight in hydroxychloroquine arm versus three in placebo arm), and cutaneous (four in hydroxychloroquine arm versus three in placebo arm).14 However, in addition they identified one person who developed a severe retinopathy while taking hydroxychloroquine. This person had taken chloroquine previously for several years and had taken a high dose of hydroxychloroquine (1200 mg) during the trial. A valuable discussion on retinal toxicity is presented by Houpt.22 A review of the systemic toxicity of chloroquine found little to support regular blood monitoring.23 A meta-analysis of toxicities places the toxicity of antimalarials in perspective.24

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