Treatment of Chronic Discoid Lupus Erythematosus With Chloroquine (Aralen)

Abstract

fluids was begun six hours postoperatively and continued at two hour intervals, always preceded by administration of pro¬ caine amide, 15 mg. in aqueous solution. No vomiting was present in the postoperative period, and procaine amide therapy was discontinued on the sixth postoperative day.Comment.-It is not unusual for an infant to vomit for a short time after pyloromyotomy because of the dis¬ turbed physiology in the operative area. The fact that all feedings were retained after the first dose of procaine amide strongly suggests that there was an element of residual spasm in the pyloric region and that it was re¬ lieved by therapy with the drug. The use of procaine amide solution in the postoperative management of in¬ fants undergoing pyloromyotomy is suggested by case 5. Cases 5 and 6 both illustrate that procaine amide therapy given in the presence of a pyloric tumor mass has no significant effect in the relief of vomiting. The immediate cessation of vomiting after pyloromyotomy and the ad¬ ministration of procaine amide indicated a complemen¬ tary effect of this antispasmodic. SUMMARYThe use of procaine amide (Pronestyl) in pylorospasm has not been previously reported. Its mode of action in the alleviation of spasm of the upper gastrointestinal tract is unknown. On the basis of our knowledge of the phar¬ macology of this drug, we postulate that its mode of action is due to anesthetization of the gastric mucosa that causes a diminution in local irritability and an elevation of thresholds to all gastrointestinal stimuli, a relaxation of the pyloric sphincter, and a quiescence of all gastro¬ intestinal motility. Investigations to test this hypothesis are in progress.The findings in these cases and the course of the infants described here suggests that procaine amide can play an important role in the alleviation of spasm in the upper gastrointestinal tract of infants. Four cases of pyloro¬ spasm in which marked improvement followed its use are presented. It did not appear to be of benefit in two cases of congenital hypertrophie pyloric stenosis in alleviating vomiting before pyloromyotomy. It seemed to be helpful in the postoperative management of these patients. It may prove to be an aid as a therapeutic test in pylorospasm. Further trial of procaine amide administered orally in pylorospasm in infants is suggested. It must be pointed out, however, that any child receiving procaine amide should be checked carefully for the various side-actions of this drug. Although these effects have not been ob¬ served, we have watched carefully for evidence of cardiac changes, central nervous system stimulation or depres¬ sion, and blood constituent changes. In another study on this drug,3 we saw minimal side-actions. In several pa¬ tients who have used procaine amide for periods over a year for arthritic pain, we have not seen changes. How¬ ever, too few cases have been reported for definite con¬ clusion to be reached. In an adult study to be reported at a later date, we found that gastric retention of various types have on ...

Histopathology of Chloroquine Retinal Toxicity

“…7 Recently, numerous reports have appeared in the literature describing the signs and symptoms of chloroquine ocular toxicity. [8][9][10][11][12][13][14][15][16][17][18] Formerly, the ocular side effects were considered transient and reversible.…”

Antimalarials in the Treatment of Discoid Lupus Erythematosus

“…The 14 patients (Cases 17-30) who had received no antimalarial prior to chloroquine fared well on it except Cases 26 and 27. Seven of this group had one or more remis¬ sions exceeding two months ; four had some improvement but no remission ; one has been on the drug 18 months and is improving slowly (Case 21).…”

“…Five patients reached a degree of improvement after treatment for three months which was considered satisfactory, and the drug was omitted, but each had to be re-treated for reactivation within an average of three months (Cases 3,8,9,11,14). Ten pa¬ tients had some encouraging improvement at the beginning and continued quinacrine for 2 to 10 months before abandoning treat¬ ment or switching to chloroquine (Cases 1, 2, 4-7, 10, 12,13,15).…”

Tissue distribution and tumor concentrations of hydroxychloroquine and quinacrine analogs in mice

“…The lysosomotropic characteristics of HCQ render erythrocyte lysosomes inactive, effectively starving Plasmodium parasites and eliminating these disease-causing organisms (3–5). HCQ is also used to treat various autoimmune diseases, including rheumatoid arthritis and systemic lupus erythematosus (6–9). Further, HCQ is being used in cancer clinical trials as an inhibitor of macroautophagy, a cytosolic degradation process employing the lysosome (10–12).…”