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Irreversible retinal damage has been observed in some patients who had received long-term or highdosage 4-aminoquinoline therapy for discoid and systemic lupus erythematosusor rheumatoid arthritis.

The side effects listed below are not experienced by everyone who takes this medicationIf you are concerned about side effectsdiscuss the risks and benefits of this medication with your doctor.

Before starting a long-term treatmentboth eyes should be carefully examined for visual acuitycentral visual fieldand color visionExamination should also include fundoscopyThese examinations should be repeated at least annuallyRetinal toxicity is largely dose-related.

Skeletal muscle palsies or skeletal muscle myopathy or neuromyopathy leading to progressive weakness and atrophy of proximal muscle groups which may be associated with mild sensory changesdepression of tendon reflexes and abnormal nerve conduction.

Avoid other hepatotoxicdermatotoxicQT-prolonging drugsIncreased ocular toxicity with concomitant tamoxifenMay potentiate digoxincyclosporinemonitorMay need to reduce dose of concomitant insulin or antidiabetic drugsIncreased seizure risk with other antimalarialsegmefloquineIncreased toxicity with methotrexateMay affect antiepileptics.

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