These actions in-turn also responsible for the adverse effect of HCQ under long-run treatment. 5522L from blood and 44,257L from plasma) with 45 -50% protein binding. It metabolized in the liver via N-dealkylated catalyzed by CYP3A4 (Figure ) and mostly eliminated through the kidney (elimination half-life 32-50 days) with clearance rate is 96 mL/min. The common adverse effects are nausea, stomach cramps, and diarrhea. The chronic use of HCQ adversely resulting in dose-dependent retinopathy (eye), hepatotoxicity (liver), anemia, hearing loss, psoriasis, etc. HCQ overdose may cause additional cardiovascular collapse, convulsions, and hypokalaemia, etc. which may lead to cardiac arrest and death. Such conditions should be treated with instant gastric lavage and activated charcoal along with parenteral diazepam to treat cardiotoxicity. If taken concurrently, arrhythmogenic drugs, and drugs known for QT prolongation can interact with HCQ and increases the risk of induced ventricular arrhythmias. An utmost care should be taken by pregnant women or nursing mothers. 42