INTRODUCTION

Hydroxychloroquine, commonly known by brand names like Plaquenil and Quineprox, belongs to a group of medicines called antimalarial quinolines and is also used as an antirheumatic. This medication is typically prescribed to treat and prevent malaria, a disease caused by parasites transmitted through mosquito bites. It is also effective in managing autoimmune diseases such as rheumatoid arthritis and lupus, where it helps reduce inflammation.

WHAT is Hydroxychloroquine?

Hydroxychloroquine is a medication that belongs to the quinoline class and is primarily used to prevent or treat malaria. Malaria is a disease spread by mosquitoes, prevalent in regions like Africa, South America, and Southern Asia. However, hydroxychloroquine does not work against all types of malaria, particularly those strains resistant to a similar drug, chloroquine.

In addition to its use in combating malaria, hydroxychloroquine is also prescribed for managing symptoms of rheumatoid arthritis and lupus, specifically discoid or systemic lupus erythematosus. This helps in reducing inflammation associated with these autoimmune diseases.

Hydroxychloroquine is a medication used to treat and prevent malaria and to alleviate symptoms of autoimmune conditions like lupus and rheumatoid arthritis. However, it comes with significant risks, especially when used with other medications such as the antibiotic azithromycin. This combination can lead to severe heart issues, including rapid or pounding heartbeats and dizziness, which might cause fainting.

Warnings

Long-term or high-dose use of hydroxychloroquine may permanently damage the retina, leading to serious vision problems. If you experience vision changes such as blurriness, trouble focusing, or sensitivity to light, stop taking the medication and contact your doctor immediately.

Hydroxychloroquine is not recommended for individuals under 18 years old for lupus or rheumatoid arthritis treatment. Additionally, breastfeeding while using this drug may not be safe. Before starting treatment, ensure you are not allergic to hydroxychloroquine or similar drugs like chloroquine.

Before taking this medicine

Discuss with your doctor if you have a history of conditions like heart disease, vision problems from previous anti-malaria medication use, or kidney and liver diseases, as these can increase the risks associated with hydroxychloroquine. Also, inform your doctor if you are pregnant or planning to become pregnant. Malaria poses a high risk to pregnant women and could lead to complications like miscarriage or low birth weight.

If you are pregnant, you might be added to a pregnancy registry to monitor the drug’s effects on your baby. Since the effects of hydroxychloroquine on an unborn child are unclear, weigh the risks of exposure to malaria with your doctor if you are considering travel to high-risk areas.

To use hydroxychloroquine safely and effectively, follow your doctor’s instructions precisely. Always take it with a meal or a glass of milk to aid absorption, unless advised otherwise by your doctor. Do not crush or break the tablet.

How should I take hydroxychloroquine?

For treating lupus or arthritis, hydroxychloroquine is typically taken daily. To prevent malaria, start taking hydroxychloroquine weekly, beginning two weeks before you travel to an area where malaria is common, and continue for four weeks after leaving. For treating malaria, a high initial dose is followed by smaller doses over the next two days.

Continue using hydroxychloroquine for the entire duration prescribed, even if you feel better quickly. If you believe you’ve been exposed to malaria or develop fever or other symptoms after visiting a malaria-prone area, contact your doctor immediately.

To further protect against mosquito bites that could cause malaria, wear protective clothing, use insect repellent, and sleep under mosquito netting.

Remember, no medicine guarantees complete protection against all types of malaria. If you experience fever, vomiting, or diarrhea while taking hydroxychloroquine, discuss it with your doctor. Regular medical and vision exams are recommended during treatment.

Store hydroxychloroquine in a cool, dry place away from direct light and heat.

Dosing information

For malaria prevention, adults typically take 400 mg of hydroxychloroquine once a week, which corresponds to 310 mg of the base. This dose is the same regardless of weight unless otherwise specified, with the maximum allowed per dose being 400 mg. It’s important to take the drug on the same day each week, starting two weeks before exposure to malaria and continuing for four weeks after leaving the endemic area. This regimen is recommended in regions where there is no reported resistance to chloroquine.

The U.S. Centers for Disease Control and Prevention (CDC) suggests a similar weekly dosage of 310 mg base (400 mg salt) for areas with chloroquine-sensitive malaria. Prophylaxis should start 1-2 weeks before traveling to a malarious area and continue weekly while there and for four weeks afterward. Hydroxychloroquine should not be used for treatment if malaria develops while on prophylaxis.

For treating malaria, the usual adult dosage is 800 mg of hydroxychloroquine salt (620 mg base) initially, followed by 400 mg (310 mg base) at 6, 24, and 48 hours after the first dose, totaling 2000 mg salt (1550 mg base). Weight-based dosing starts at 13 mg/kg (10 mg/kg base), with subsequent doses at 6.5 mg/kg (5 mg/kg base) administered at 6, 24, and 48 hours after the initial dose.

The CDC’s recommendation for treating uncomplicated malaria includes a similar initial and follow-up dosing schedule. Treatment often requires combination with an 8-aminoquinoline compound, particularly for infections caused by Plasmodium vivax and P. ovale, to achieve a radical cure. For pregnant women in regions where malaria is chloroquine-sensitive, this treatment protocol is also recommended. Always consult current guidelines for the most up-to-date information and to ensure proper management and safety considerations based on the specific region and type of malaria.

For systemic lupus erythematosus, adults usually take 200 to 400 mg of hydroxychloroquine (155 to 310 mg base) daily, split into one or two doses. It’s important not to exceed 400 mg per day as higher doses can increase the risk of retinopathy, a serious eye condition. This medication is used for treating both chronic discoid lupus erythematosus and systemic lupus erythematosus.

For rheumatoid arthritis, the initial dose ranges from 400 to 600 mg of hydroxychloroquine (310 to 465 mg base) daily, which can be divided into one or two doses. Once a good response is achieved, the dose can be reduced by 50% and maintained at 200 to 400 mg per day. The maximum dose should not exceed 600 mg per day or 6.5 mg/kg per day, whichever is lower, to avoid the risk of retinopathy. Hydroxychloroquine may be used alongside corticosteroids and salicylates, which can often be reduced once a maintenance dose is established. This regimen is intended for the treatment of both acute and chronic rheumatoid arthritis.

For malaria prophylaxis in children, the dose is 6.5 mg/kg of hydroxychloroquine (5 mg/kg base) taken orally once a week, with the maximum dose capped at 400 mg. Prophylaxis should start two weeks before exposure to malaria and continue for four weeks after leaving the area. This dosing schedule is recommended in regions without reported chloroquine resistance. The CDC recommends a slightly different pediatric dose of 5 mg/kg base (6.5 mg/kg salt) weekly.

For treating uncomplicated malaria in children, the initial dose is 13 mg/kg (10 mg/kg base), followed by three more doses of 6.5 mg/kg (5 mg/kg base) over the next two days. The maximum dose for each stage of treatment should not exceed the adult maximum dose. Treatment for malaria caused by P. vivax and P. ovale may require additional therapy with an 8-aminoquinoline compound for a radical cure.

It’s essential to consult current guidelines for detailed information on dosing schedules, regional drug resistance, and co-administration with other medications.

If you miss a dose of hydroxychloroquine, contact your doctor for advice on what to do next. In case of an overdose, which can be fatal, seek immediate emergency medical help or call the Poison Help line at 1-800-222-1222. Symptoms of an overdose include drowsiness, vision changes, seizures, a slow or weak pulse, rapid heartbeats, dizziness, fainting, and difficulty breathing.

Keep hydroxychloroquine out of children’s reach as ingestion can be deadly.

Precautions to Take:

Hydroxychloroquine may blur your vision or impair your ability to react. Avoid driving or engaging in hazardous activities until you know how the medication affects you. Also, avoid taking antacids or Kaopectate within four hours before or after taking hydroxychloroquine, as they can affect how well your body absorbs the medicine.

Potential Serious Side Effects:

Immediate medical attention is necessary if you experience signs of an allergic reaction (such as hives, breathing difficulties, or facial swelling) or severe skin reactions (including fever, sore throat, burning eyes, painful skin, or a red or purple rash that blisters and peels).

You should also seek help if you exhibit symptoms of a severe heart issue, such as rapid or pounding heartbeats, chest fluttering, shortness of breath, or sudden dizziness.

Contact your doctor immediately if you have any of the following:

• Seizures.
• Yellowing of the eyes.
• Ringing in the ears or hearing problems.
• Unusual mood swings.
• Severe muscle weakness or coordination loss.
• Unexpected changes in mood or thoughts of suicide.
• Signs of low blood cell counts (fever, chills, fatigue, mouth sores, easy bruising or bleeding, pale skin, cold hands and feet).
• Symptoms of low blood sugar (headache, excessive hunger, sweating, irritability, dizziness, rapid heartbeat, feeling jittery).
• Signs of a severe drug reaction, such as skin rash, fever, swollen glands, muscle aches, significant weakness, unusual bruising, or skin and eye yellowing.

Long-term or high-dose use of hydroxychloroquine may cause irreversible damage to your eyes, specifically the retina. If you experience vision disturbances such as blurriness, trouble focusing, seeing flashes of light, or heightened sensitivity to light, stop taking the medication and inform your doctor.

What other drugs will affect hydroxychloroquine?

Common side effects of hydroxychloroquine include headaches, dizziness, nausea, vomiting, stomach pain, loss of appetite, weight loss, nervousness, irritability, skin rashes, itching, and hair loss. This list does not cover all possible side effects. If you experience any side effects or have concerns, contact your doctor for advice. You can also report side effects to the FDA at 1-800-FDA-1088.

Hydroxychloroquine can lead to serious heart issues, particularly when used with other medications that treat conditions like infections, asthma, heart disorders, high blood pressure, mental illnesses, depression, cancer, malaria, or HIV.

It’s important to inform your doctor about all medications you’re taking, including:

• Cimetidine
• Cyclosporine
• Methotrexate
• Rifampicin
• Praziquantel
• Ampicillin
• Digoxin
• Tamoxifen
• Medications for heart rhythm

This is not an exhaustive list. Hydroxychloroquine may interact with other prescription and over-the-counter medicines, vitamins, and herbal products. Be sure to discuss all your medications with your doctor to safely manage potential interactions.

Here’s more information on hydroxychloroquine:

Hydroxychloroquine belongs to the drug class known as antimalarial quinolines. It is commonly prescribed under the brand names Plaquenil and Sovuna. This medication is used to treat conditions such as rheumatoid arthritis, lupus, lichen planopilaris, and arthritis associated with Lyme disease.

When considering hydroxychloroquine, you can check drug interactions, compare alternatives, and look up pricing and coupons. Reviews from users and images of the drug are also available. Important information including the latest FDA alerts, side effects, and dosage guidelines are accessible, as well as specific advice regarding its use during pregnancy and breastfeeding.

For those who speak Spanish, patient resources are available in español. Professional healthcare providers can refer to detailed resources like the hydroxychloroquine monograph and the FDA’s hydroxychloroquine tablets information.

It’s crucial to keep this and all other medications out of the reach of children, never share your medicines with others, and use hydroxychloroquine strictly as prescribed by your healthcare provider. Always consult your healthcare provider to ensure the information is relevant to your personal circumstances and to obtain guidance tailored to your health needs.

FAQS

What safety measures are important while taking hydroxychloroquine?

When using hydroxychloroquine, it’s crucial to practice gentle oral hygiene by brushing and flossing carefully to avoid gum injuries. Use caution with sharp objects such as razors and nail clippers. If you experience signs of an infection like fever, chills, cough, hoarseness, pain in the lower back or side, or painful or difficult urination, contact your doctor immediately.

What foods should be avoided with hydroxychloroquine?

While taking hydroxychloroquine, it’s advisable to reduce your intake of grapefruit and grapefruit juice. Grapefruit can raise the blood levels of hydroxychloroquine, potentially leading to an irregular heartbeat and other heart-related issues.

Who should avoid taking hydroxychloroquine?

Individuals should not take hydroxychloroquine if they have had an allergic reaction to it or similar medications like quinolones or quinine. It is also contraindicated for those with certain eye problems affecting the retina, such as maculopathy, or other serious eye conditions. Additionally, it should be avoided by those who are pregnant, trying to conceive, breastfeeding, or have specific liver, kidney, heart, or blood disorders.

How can you tell if hydroxychloroquine is effective?

Hydroxychloroquine’s effectiveness is typically observed through a reduction in pain, swelling, and joint stiffness over time. For those with lupus, an improvement in skin rashes may also indicate that the medication is working. It can take up to 12 weeks to notice these benefits.

What is the major toxic effect of hydroxychloroquine?

The primary toxic effect of hydroxychloroquine is damage to the eye’s retina, particularly through conditions like macular edema and granular depigmentation of the retinal pigment epithelium (RPE) in the macula. Prolonged use can lead to atrophic bullseye maculopathy, characterized by concentric rings of pigmentation changes around the fovea.