Chloroquine-induced pruritus remains one of the most common side-effects in the use of chloroquine in the prophylaxis and treatment of uncomplicated malaria before the advent of artemisinin-based combination therapies. It has been reported to vary from a tolerable to intolerable intensity among susceptible individuals resulting in disruption of treatment and development of resistance to the drug thus leading to therapeutic failures as reported. This scourge is quite challenging due to the complex physiologic mechanism that has not been fully elucidated. Factors observed to be responsible in the induction of pruritus such as age, race, heredity, density of parasitaemia; impurities in formulations, plasmodial specie, dosage form and metabolites have been discussed in this review. Efforts to ameliorate this burden have necessitated the use of drugs of diverse pharmacological classes such as antihistamines, corticosteroids and multivitamins either alone or as a combination. This review is to look into the use of chloroquine retrospectively, and consider its re-introduction due to its safety. Efficacy can be attained if the pruritic effect is resolved.
Hospital records of patients seen between 1999 and 2002 were carefully examined. A questionnaire was used to extract relevant information from the case records and clinical diagnosis was made using the ICD-10. Cases that had evidence of pre-existing psychiatric disorder, family history of mental illness or heavy use of alcohol and/or tobacco were excluded. Out of 6,556 patients that were seen for the first time, 849 were drug-related cases and 601 of these were primarily cannabis users. A substantial number (83%) of these were young and presented with severe psychopathologies. About 90% and 47% were diagnosed with psychotic disorders and dependence syndrome, respectively. It is concluded that cannabis use is associated with severe psychopathologies and constituted over 70% of demand for treatment.
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