Hydroxychloroquine: Effective Antimalarial and Immunomodulatory Therapy
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| Product dosage: 400mg | |||
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Synonyms | |||
Hydroxychloroquine is a prescription medication belonging to the class of drugs known as antimalarials and disease-modifying antirheumatic drugs (DMARDs). It is widely utilized for its dual therapeutic roles in both preventing and treating malaria and in managing autoimmune conditions such as rheumatoid arthritis and systemic lupus erythematosus. Its mechanism involves altering immune responses and interfering with parasitic activity, offering patients a well-established option for long-term disease control. This product card provides a comprehensive, expert-level overview tailored for healthcare professionals and informed patients.
Features
- Active ingredient: Hydroxychloroquine sulfate
- Available forms: Oral tablets (200 mg base equivalent to 155 mg base or 250 mg salt, depending on manufacturer)
- Prescription-only medication
- Long half-life allowing for once-daily or weekly dosing regimens
- Generic and brand-name formulations available (e.g., Plaquenil®)
- Stable at room temperature with proper storage
Benefits
- Effectively prevents and treats malaria caused by susceptible strains of Plasmodium
- Reduces pain, swelling, and joint damage in autoimmune disorders like rheumatoid arthritis
- Helps control disease activity and prevent flares in systemic lupus erythematosus
- May improve skin manifestations and fatigue in lupus patients
- Offers a cost-effective, widely available therapeutic option with decades of clinical use
- Generally well-tolerated with a predictable safety profile when monitored appropriately
Common use
Hydroxychloroquine is primarily indicated for:
- Prophylaxis and treatment of acute malaria (in regions where Plasmodium strains are susceptible)
- Management of chronic inflammatory rheumatic diseases, including rheumatoid arthritis
- Treatment of systemic lupus erythematosus, particularly for cutaneous and joint symptoms
- Off-label uses may include Sjögren’s syndrome, porphyria cutanea tarda, and certain photodermatoses, under specialist supervision
Dosage and direction
Dosage must be individualized based on indication, patient weight, renal function, and concomitant medications.
- Malaria prophylaxis: 400 mg (salt) orally once weekly, starting 1-2 weeks before travel and continuing for 4 weeks after leaving endemic area
- Acute malaria treatment: Initial dose of 800 mg followed by 400 mg at 6, 24, and 48 hours (total 2 g)
- Rheumatoid arthritis/lupus: 200-400 mg daily, often starting lower and titrating based on response and tolerability
Always take with food or milk to minimize gastrointestinal upset. Regular ophthalmic exams are recommended due to retinopathy risk.
Precautions
- Requires baseline and periodic ophthalmologic examinations (every 6-12 months) to screen for retinal toxicity
- Use with caution in patients with hepatic impairment, severe gastrointestinal disorders, or neurological conditions
- May exacerbate psoriasis or precipitate porphyria
- Not recommended during pregnancy unless potential benefit justifies potential risk (FDA Pregnancy Category C)
- Breastfeeding should be discussed with a healthcare provider, as the drug is excreted in milk
Contraindications
- Known hypersensitivity to hydroxychloroquine, chloroquine, or any component of the formulation
- Pre-existing retinal field changes attributable to antimalarials
- Concurrent use of other drugs known to cause retinal toxicity or myopathy
- G6PD deficiency (in certain populations for malaria treatment)
Possible side effect
Common side effects (often dose-related and transient):
- Nausea, vomiting, abdominal cramps, diarrhea
- Headache, dizziness
- Pruritus, skin rash
- Hair loss or bleaching
Serious side effects (require medical attention):
- Irreversible retinopathy with long-term use
- Cardiomyopathy or conduction defects
- Blood dyscrasias (e.g., leukopenia, thrombocytopenia)
- Severe hypoglycemia
- Neuropsychiatric events (e.g., anxiety, psychosis)
Drug interaction
- May enhance effects of insulin and oral hypoglycemics
- Digoxin levels may increase
- Antacids and kaolin can reduce absorption (separate administration by ≥4 hours)
- May increase risk of myopathy when used with other myotoxic drugs
- CYP2D6 inhibitors may elevate hydroxychloroquine levels
Missed dose
- If a dose is missed, take it as soon as remembered unless it is almost time for the next dose.
- Do not double the dose to make up for a missed one.
- For weekly prophylaxis: If a dose is missed, take it as soon as possible, then resume the regular weekly schedule.
Overdose
Symptoms may include headache, drowsiness, visual disturbances, cardiovascular collapse, seizures, and hypokalemia. Overdose is potentially fatal and requires immediate medical attention. Treatment is supportive; gastric lavage and activated charcoal may be beneficial if administered early.
Storage
- Store at room temperature (15-30°C)
- Keep in the original container, tightly closed
- Protect from light and moisture
- Keep out of reach of children and pets
Disclaimer
This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or changing any medication regimen. Dosage and indications may vary based on regional guidelines and individual patient factors.
Reviews
Hydroxychloroquine has been extensively studied and used since the 1950s. Clinical trials and real-world evidence support its efficacy in malaria and autoimmune diseases, though retinal toxicity remains a significant concern with prolonged use. More recent studies have explored its potential in other conditions, though such uses should be approached with caution and under specialist guidance. Patient experiences often note improvement in autoimmune symptoms, with tolerability being generally favorable under appropriate monitoring.