Problems Related to Antimalarial Drugs
| Problem | Drug/s | Differentiation from severe malaria | Treatment |
|---|---|---|---|
| Vomiting | Chloroquine, Quinine, Mefloquine, Halofantrine, Tetracyclines, Primaquine | Vomiting is even otherwise common in malaria, usually at the height of fever. | Anti emetics like Domperidone and Metaclopramide. In the young, metaclopramide can cause extra- pyramidal signs, so Promethazine can be tried. |
| Dizziness | Chloroquine, Quinine, Mefloquine, Halofantrine | Could be due to high fever, dehydration and postural hypotension. | Usually mild; if bothersome, drugs like Cinnarazine, Betahistine etc. can be used |
| Itching | Chloroquine | Anti histamines can be tried | |
| Pain abdomen: Drug induced gastritis causes mild discomfort and very rarely abdominal cramps | Chloroquine, Quinine, Mefloquine, Primaquine | In malaria, particularly falciparum, there may be acute pain over upper abdomen or right lower abdomen, mimicking acute abdominal syndromes. | Drug induced pain can be managed with antacids or H2 receptor blockers. |
| Altered behaviour, confusion, delirium, hallucinations, etc. Drug induced alterations in behaviour and changes in the level of consciousness usually appear after 24-48 hours of starting treatment. By then the fever and parasitemia may be lower. And this can occur on treatment for any type of malaria. | Chloroquine, Quinine, Mefloquine | These symptoms can be due to severe falciparum infection or due to high grade fever in any type of malaria. If these problems are caused by severe infection, then peripheral blood should show falciparum infection, high degree of parasitemia and the patient may have other symptoms and signs of severe malaria viz. anemia, hyperpyrexia, jaundice etc. | Watchful expectancy; if needed, tranquilizers like Haloperidol can be used. |
| Convulsions Some antimalarials can induce convulsions. It may also be due to hypoglycemia induced by quinine. | Chloroquine, Quinine, Mefloquine | In severe malaria, convulsions may be recurrent and may lead to unarousable coma. | Anticonvulsants like phenobarbitone for recurrent convulsions. Mefloquine is better avoided in known epileptics. |
| Coma | Quinine can cause hypoglycemia, which may present as coma. | In cerebral malaria, coma persists even after infusion of 50% dextrose | 25-50% dextrose, 50-100 ml intravenously |
| Hypoglycemia | Quinine | In severe falciparum malaria, especially in pregnancy and children, hypoglycemia can occur even without quinine therapy | 25-50% dextrose, 50-100 ml intravenously |
| Anemia | Primaquine can cause massive hemolysis in patients with G6PD deficiency | Anemia is a common feature in malaria, especially in children. | Usually self-limiting; withdraw the drug; blood or packed cell transfusion if needed. |
| Jaundice | Primaquine may cause hemolytic jaundice in patients with G6PD deficiency | Severe malaria can cause hemolytic jaundice, or rarely malarial hepatitis | Withdraw the drug |
| Hemoglobinuria | Primaquine (same as above) | ||
| Fever Continuing even after improvement in general condition and significant reduction in parasitemia. | Artemisinin derivatives | In cases of resistant malaria, with the continuation of fever, the general condition deteriorates and parasitemia increases. | Self-limiting, disappears after the drug is stopped. |
©malariasite.com ©BS Kakkilaya | Last Updated: Jan 2, 2018