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In Zimbabwe, cases of poisoning by a single agent were identified in a retrospective hospital record review. The mortality rate from chloroquine poisoning was significantly higher than from poisoning with other drugs 5. Overdose with hydroxychloroquine is far less common than with chloroquine. Three of eight patients died.
Life-threatening symptoms, such as hypotension, conduction disturbances, and hypokalemia can occur within 30 minutes of ingestion and are similar to those seen in chloroquine overdose.
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The lethal plasma concentration of hydroxychloroquine is not well established. Serious toxicity has been reported at plasma concentrations of 2. Management of hydroxychloroquine overdose is similar to that of chloroquine overdose, including the use of charcoal for drug adsorption, diazepam for seizures and sedation, early intubation and mechanical ventilation, and potassium replacement for severe hypokalemia. Electrocardiographic changes, comprising altered T waves and prolongation of the QT interval, are not uncommon during high-dose treatment with chloroquine.
The clinical significance of this is uncertain.
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With chronic intoxication, a varying degree of atrioventricular block can be seen; first-degree right bundle branch block and total atrioventricular block have been described. Symptoms depend on the severity of the effects: syncope, Stokes-Adams attacks, and signs of cardiac failure can occur. Cardiac complications can prove fatal in both chronic and acute intoxication. Third-degree atrioventricular conduction defects have been reported in two patients with rheumatoid arthritis after prolonged administration of chloroquine.
Long-term chloroquine can cause cardiac complications, such as conduction disorders and cardiomyopathy restrictive or hypertrophic , by structural alteration of the interventricular septum.