Dominic Stone
Hydroxychloroquine is an oral medication used to treat and prevent malaria. It is also used to treat lupus and arthritis. While hydroxychloroquine is a useful medication, it can cause side effects, and it may affect people differently. One of the known side effects of hydroxychloroquine is muscle weakness, which can be caused by nerve damage. This side effect is more likely to occur with long-term use and higher doses of the medication, particularly in older patients or those with kidney issues. If you experience muscle weakness while taking hydroxychloroquine, it is important to consult your doctor or healthcare provider.
| Characteristics | Values |
|---|---|
| Muscle Weakness | Hydroxychloroquine can cause muscle weakness, cramps, stiffness, spasms, and pain, a condition known as myopathy. |
| Nerve Problems | It can also lead to nerve problems called neuropathy, which can manifest as pain, burning, tingling, or numbness. |
| Risk Factors | The risk of muscle weakness increases with long-term use, higher doses, and in individuals with kidney issues or advanced age. |
| Prevalence | Studies suggest that muscle weakness can occur in up to 13% of people receiving long-term treatment with hydroxychloroquine. |
| Treatment | Discontinuing the medication typically leads to improvement, but patients may not return to their baseline muscle strength. |
| Prevention | Healthcare providers may monitor muscle strength and reflexes during treatment and advise stopping the medication if weakness interferes with daily activities. |
| Other Side Effects | Hydroxychloroquine may also cause heart rhythm problems, skin reactions, eye problems, low blood sugar, and respiratory issues. |
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What You'll Learn
Nerve damage can lead to muscle weakness
Hydroxychloroquine is an oral medication used to treat and prevent malaria. It is also used to treat lupus and arthritis. Like all medicines, it can cause side effects, including muscle weakness, cramps, stiffness, spasms, and skin reactions.
There are many causes of nerve damage, including:
- Alcohol use disorder: Excessive alcohol intake, especially over long periods, can damage nerves and contribute to vitamin deficiencies that lead to peripheral neuropathy.
- Vitamin and nutrient deficiencies: Deficiencies in copper and vitamins B1, B6, B9, B12, folic acid (B9), and E can cause nerve damage.
- Autoimmune and inflammatory conditions: Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP) can cause severe weakness and nerve damage.
- Medications and toxins: Certain medications, such as antibiotics and drugs that treat arrhythmia and gout, can cause peripheral neuropathy.
- Diabetes: Poorly controlled diabetes can damage nerves.
It is important to seek medical advice if you experience any signs of nerve damage or muscle weakness, especially if you are taking hydroxychloroquine or any other medication.
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Myopathy and neuropathy
Myopathy accompanying neuropathy is extremely rare. Clinical features alone may be insufficient to distinguish myopathy from neuropathy. Electrodiagnostic studies such as needle electromyography (EMG), nerve conduction studies (NCS), and muscle biopsies are typically required to confirm the diagnosis.
Chloroquine (CQ) and its derivative hydroxychloroquine (HCQ) have been associated with muscle toxicity, often described as a proximal myopathy. This is characterised by the accumulation of autophagic vacuoles, increased acid phosphatase reactivity, and the detection of myeloid or curvilinear bodies on electron microscopy. Long-term exposure to CQ and HCQ may result in a myopathy with a wide spectrum of clinical presentations, often with marked associated morbidity.
Patients with neck weakness reported difficulty lifting their heads when lying supine, with one reporting a head drop. Limb involvement was predominantly proximal, affecting both upper and lower limbs, with either normal or mild distal involvement. Axial involvement affected mostly the neck muscles, involving flexors and extensors.
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Muscle pain, cramps, stiffness, spasms
Hydroxychloroquine is a medication used to treat and prevent malaria, as well as to treat lupus and arthritis. While it is a useful medication, it can cause a range of side effects, including muscle problems.
Muscle pain, cramps, stiffness, and spasms
Muscle problems are a known side effect of hydroxychloroquine. These issues can manifest as muscle pain, weakness, and tenderness, often referred to as myopathy. Myopathy is characterised by the accumulation of autophagic vacuoles, increased acid phosphatase reactivity, and the presence of myeloid or curvilinear bodies on electron microscopy. The onset of myopathy symptoms can be delayed, and patients may not experience these issues until they have been taking the medication for several months or even years.
In addition to pain, individuals taking hydroxychloroquine may experience muscle cramps, stiffness, or spasms. These symptoms can be indicative of underlying muscle toxicity or neuropathy, which is nerve damage that can lead to muscle weakness. In some cases, hydroxychloroquine can cause marked difficulty in lifting the head when lying down, a symptom known as head drop.
The risk of muscle problems increases with long-term use and higher doses of hydroxychloroquine. Elderly individuals and those with kidney issues are also at a higher risk for these side effects. Therefore, it is important for healthcare providers to monitor patients' muscle strength and reflexes while they are taking this medication. If you experience any muscle pain, weakness, or other related symptoms, it is important to consult your doctor or healthcare provider.
To manage muscle pain and related discomfort, it is recommended to rest and relax. Applying a heat pad or using a hot water bottle can also provide relief. Additionally, maintaining proper hydration by drinking small and frequent sips of water is important, especially if you are experiencing nausea or vomiting, which are other common side effects of hydroxychloroquine.
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Proximal myopathy and lysosomal dysfunction
Proximal myopathy is a condition that presents as generalised muscle weakness, commonly affecting the muscles in the upper and/or lower limbs. It is characterised by muscle weakness that is either non-progressive or very slowly progressive, with some cases involving intermittent periods of normal strength. Proximal myopathy can be caused by toxins, long-term use of certain medications, endocrine and metabolic disorders, and inflammatory conditions.
Hydroxychloroquine (HCQ) and its derivative, chloroquine (CQ), have been associated with muscle toxicity, particularly proximal myopathy. This occurs due to the drugs' affinity for acidic compartments such as lysosomes, which results in altered lysosomal function, autophagy, and signalling pathways. The accumulation of autophagic vacuoles within muscle fibres can lead to the disruption of myofibrillar structures and ultimately, muscle breakdown.
Lysosomal dysfunction, as observed in lysosomal storage disorders (LSDs), negatively impacts mitochondrial function, likely through the suppression of mitophagy. Mitophagy is a process that targets and degrades poorly functioning mitochondria in response to contractile activity. In normal skeletal and cardiac muscles, lysosomes are not readily visible on light microscopy. However, in neuromuscular disorders, lysosomes have been shown to be structurally abnormal and functionally impaired, leading to the accumulation of autophagic vacuoles.
In the context of hydroxychloroquine-induced proximal myopathy, studies have identified patients with a median age of 66 years, predominantly female, who had been taking the drug for a minimum of 6 months and up to 21 years. The onset of symptoms was often delayed, and patients experienced a wide spectrum of clinical presentations, including swallowing, respiratory, and cardiac muscle involvement. Once the drug was discontinued, patients usually improved but often did not return to their baseline level of functioning.
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Long-term use and higher doses increase risk
Hydroxychloroquine can cause muscle problems, including muscle pain, weakness, and tenderness, known as myopathy. Myopathy is characterised by the accumulation of autophagic vacuoles, with abnormally increased acid phosphatase reactivity and the detection of myeloid or curvilinear bodies on electron microscopy. In rare cases, hydroxychloroquine can also cause nerve damage that leads to muscle weakness.
Long-term use and higher doses of hydroxychloroquine increase the risk of muscle weakness. In one study, patients with CQ or HCQ myopathy had been taking the medication for a minimum of 6 months and up to 21 years. The onset of symptoms was delayed by a median of 6 months. Higher cumulative doses and longer exposure were associated with more severe disability and more common cardiac and swallow involvement, indicating a cumulative dose effect.
The risk of muscle weakness with hydroxychloroquine use is higher in people with kidney issues or older individuals. Elderly patients are more likely to have age-related kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving this medication.
If you are experiencing muscle weakness while taking hydroxychloroquine, it is important to reach out to your healthcare team. They may monitor your muscle strength and reflexes while you are taking the medication and may perform tests to check for muscle or nerve problems.
It is important to note that hydroxychloroquine has many other side effects, and muscle weakness is a rare occurrence. Other side effects include nausea, vomiting, skin rashes, and gut-related issues. It is also important to be aware of more serious side effects, such as heart rhythm problems, low blood sugar, and suicidal thoughts or actions.
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Frequently asked questions
Yes, hydroxychloroquine can cause muscle weakness, pain, cramps, stiffness, or spasms. It can also cause nerve damage, which can lead to muscle weakness. This side effect is more likely with long-term use and higher doses of the medication.
If you experience muscle weakness or any other side effects while taking hydroxychloroquine, you should contact your healthcare provider. They may perform tests to check for muscle weakness and nerve problems and may adjust your dosage or recommend alternative medications.
Yes, other common side effects of hydroxychloroquine include nausea, vomiting, diarrhoea, skin rashes, and vision changes. More rarely, it can cause heart problems, low blood sugar, and serious skin and allergic reactions. It may also cause suicidal thoughts or actions in a small number of people.
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