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chloroquine

Pronunciation

Generic Name: chloroquine (KLOR oh kwin)
Brand Name: Aralen Phosphate, Aralen Hydrochloride

What is chloroquine?

Chloroquine is a medication to treat or prevent malaria, a disease caused by parasites. This medicine works by interfering with the growth of parasites in the red blood cells of the human body.

Parasites that cause malaria typically enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia.

Chloroquine is used to treat and to prevent malaria. Chloroquine is also used to treat infections caused by amoebae.

Chloroquine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about chloroquine?

You should not use this medication if you are allergic to chloroquine or hydroxychloroquine (Plaquenil), or if you have a history of vision changes or damage to your retina caused by chloroquine or similar anti-malaria medications.

Before you take chloroquine, tell your doctor if you have psoriasis, porphyria, liver disease, alcoholism, G6PD deficiency, or a history of problems with your vision or hearing.

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Take chloroquine for the entire length of time prescribed by your doctor. If you are taking this medicine to treat malaria, your symptoms may get better before the infection is completely treated.

Some people taking this medication over long periods of time or at high doses have developed irreversible damage to the retina of the eye. Stop taking chloroquine and call your doctor at once if you have trouble focusing, if you see light streaks or flashes in your vision, or if you notice any swelling or color changes in your eyes.

This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Call a poison control center at once and then seek emergency medical attention if you think you have used too much of this medicine. An overdose of chloroquine can be fatal, especially in children.

What should I discuss with my healthcare provider before taking chloroquine?

You should not use this medication if you are allergic to chloroquine or hydroxychloroquine (Plaquenil), or if you have a history of vision changes or damage to your retina caused by chloroquine or similar anti-malaria medications.

To make sure chloroquine is safe for you, tell your doctor about your other medical conditions, especially:

  • psoriasis;

  • porphyria;

  • liver disease;

  • alcoholism;

  • epilepsy or other seizure disorder;

  • glucose-6-phosphate dehydrogenase (G6PD) deficiency; or

  • a history of problems with your vision or hearing.

It is not known whether chloroquine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

Malaria is more likely to cause death in a pregnant woman. If you are pregnant, talk with your doctor about the risks of traveling to areas where malaria is common.

It is not known whether chloroquine passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using chloroquine.

How should I take chloroquine?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Chloroquine is sometimes given only once per week. Choose the same day each week to take this medication if you are on a weekly dosing schedule.

To prevent malaria: Start taking the medicine 2 weeks before entering an area where malaria is common. Continue taking the medicine regularly during your stay and for at least 8 weeks after you leave the area.

Take chloroquine for the entire length of time prescribed by your doctor. If you are taking this medicine to treat malaria, your symptoms may get better before the infection is completely treated.

Use chloroquine regularly to best prevent malaria. If you stop using the medication early for any reason, talk to your doctor about other forms of malaria prevention.

In addition to taking chloroquine, use protective clothing, insect repellents, and mosquito netting around your bed to further prevent mosquito bites that could cause malaria.

If you use this medication long-term, your blood will need to be tested often. You may also need eye exams, and your doctor may need to check your knee and ankle reflexes. Visit your doctor regularly.

No medication is 100% effective in treating or preventing malaria. For best results, keep using the medication as directed.

Contact your doctor as soon as possible if you have been exposed to malaria, or if you have fever or other symptoms of illness during or after a stay in an area where malaria is common.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of chloroquine can be fatal, especially in children.

Treatment of a chloroquine overdose must be started quickly. You may be told to induce vomiting right away (at home, before transport to an emergency room). Ask the poison control center how to induce vomiting in the case of an overdose.

Overdose symptoms may include headache, drowsiness, nausea, vomiting, vision changes, seizure (convulsions), slow heart rate, weak pulse, fainting, slow breathing (breathing may stop).

What should I avoid while taking chloroquine?

Avoid taking an antacid or Kaopectate (kaolin-pectin) within 4 hours before or after you take chloroquine. Some antacids can make it harder for your body to absorb chloroquine.

If you also take an antibiotic called ampicillin (Principen, Unasyn), avoid taking it within 2 hours before or after you take chloroquine. Chloroquine can make ampicillin much less effective when taken at the same time.

This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Chloroquine side effects

Some people taking this medication over long periods of time or at high doses have developed irreversible damage to the retina of the eye. Stop taking chloroquine and call your doctor at once if you have trouble focusing, if you see light streaks or flashes in your vision, or if you notice any swelling or color changes in your eyes.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using chloroquine and call your doctor at once if you have a serious side effect such as:

  • vision problems, trouble reading or seeing objects, hazy vision;

  • hearing loss or ringing in the ears;

  • seizure (convulsions);

  • severe muscle weakness, loss of coordination, underactive reflexes;

  • nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

  • severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Other, less serious side effects may be more likely to occur. Continue to take chloroquine and talk to your doctor if you experience

  • diarrhea, vomiting, stomach cramps;

  • temporary hair loss, changes in hair color; or

  • mild muscle weakness.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Chloroquine dosing information

Usual Adult Dose for Malaria Prophylaxis:

500 mg chloroquine phosphate (300 mg base) orally on the same day each week

Comments:
-If possible, suppressive therapy should start 2 weeks prior to exposure; if unable to start 2 weeks before exposure, an initial loading dose of 1 g chloroquine phosphate (600 mg base) may be taken orally in 2 divided doses, 6 hours apart.
-Suppressive therapy should continue for 8 weeks after leaving the endemic area.

Approved indication: For the suppressive treatment of malaria due to Plasmodium vivax, P malariae, P ovale, and susceptible strains of P falciparum

CDC Recommendations:
300 mg base (500 mg salt) orally once a week

Comments:
-For prophylaxis only in areas with chloroquine-sensitive malaria
-Prophylaxis should start 1 to 2 weeks before travel to malarious areas; should continue weekly (same day each week) while in malarious areas and for 4 weeks after leaving such areas.

Usual Adult Dose for Malaria:

60 kg or more: 1 g chloroquine phosphate (600 mg base) orally as an initial dose, followed by 500 mg chloroquine phosphate (300 mg base) orally after 6 to 8 hours, then 500 mg chloroquine phosphate (300 mg base) orally once a day on the next 2 consecutive days
Total dose: 2.5 g chloroquine phosphate (1.5 g base) in 3 days

Less than 60 kg:
First dose: 16.7 mg chloroquine phosphate/kg (10 mg base/kg) orally
Second dose (6 hours after first dose): 8.3 mg chloroquine phosphate/kg (5 mg base/kg) orally
Third dose (24 hours after first dose): 8.3 mg chloroquine phosphate/kg (5 mg base/kg) orally
Fourth dose (36 hours after first dose): 8.3 mg chloroquine phosphate/kg (5 mg base/kg) orally
Total dose: 41.7 mg chloroquine phosphate/kg (25 mg base/kg) in 3 days

Comments:
-Concomitant therapy with an 8-aminoquinoline compound is necessary for radical cure of malaria due to P vivax and P malariae.

Approved indication: For acute attacks of malaria due to P vivax, P malariae, P ovale, and susceptible strains of P falciparum

CDC Recommendations:
Chloroquine-sensitive uncomplicated malaria (Plasmodium species or species not identified): 600 mg base (1 g salt) orally at once, followed by 300 mg base (500 mg salt) orally at 6, 24, and 48 hours
Total dose: 1.5 g base (2.5 g salt)

Comments:
-For the treatment of uncomplicated malaria due to chloroquine-sensitive P vivax or P ovale, concomitant treatment with primaquine phosphate is recommended.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Amebiasis:

1 g chloroquine phosphate (600 mg base) orally once a day for 2 days, followed by 500 mg chloroquine phosphate (300 mg base) orally once a day for at least 2 to 3 weeks

Comments:
-Treatment is usually combined with an effective intestinal amebicide.

Approved indication: For the treatment of extraintestinal amebiasis

Usual Adult Dose for Sarcoidosis:

(Not approved by FDA)

Study (n=43)
Intrathoracic and cutaneous: 250 mg twice a day for 4 to 17 months; a treatment course should be limited to 6 months to minimize risk of ocular damage

Study (n=23)
Pulmonary: 750 mg per day for 6 months, then tapered every 2 months to 250 mg per day

Study (n=37)
Nervous system (neurosarcoidosis): 250 mg twice a day for 6 to 18 months

Usual Pediatric Dose for Malaria Prophylaxis:

Infants and children: 8.3 mg chloroquine phosphate/kg (5 mg base/kg) orally on the same day each week

Comments:
-Pediatric dose should not exceed the adult dose regardless of weight.
-If possible, suppressive therapy should start 2 weeks prior to exposure; if unable to start 2 weeks before exposure, an initial loading dose of 16.7 mg chloroquine phosphate/kg (10 mg base/kg) may be taken orally in 2 divided doses, 6 hours apart.
-Suppressive therapy should continue for 8 weeks after leaving the endemic area.

Approved indication: For the suppressive treatment of malaria due to P vivax, P malariae, P ovale, and susceptible strains of P falciparum

CDC Recommendations:
5 mg base/kg (8.4 mg salt/kg) orally once a week
Maximum dose: 300 mg base/dose (500 mg salt/dose)

Comments:
-For prophylaxis only in areas with chloroquine-sensitive malaria
-Prophylaxis should start 1 to 2 weeks before travel to malarious areas; should continue weekly (same day each week) while in malarious areas and for 4 weeks after leaving such areas.

Usual Pediatric Dose for Malaria:

Infants and children:
Less than 60 kg:
First dose: 16.7 mg chloroquine phosphate/kg (10 mg base/kg) orally
Second dose (6 hours after first dose): 8.3 mg chloroquine phosphate/kg (5 mg base/kg) orally
Third dose (24 hours after first dose): 8.3 mg chloroquine phosphate/kg (5 mg base/kg) orally
Fourth dose (36 hours after first dose): 8.3 mg chloroquine phosphate/kg (5 mg base/kg) orally
Total dose: 41.7 mg chloroquine phosphate/kg (25 mg base/kg) in 3 days

60 kg or more:
First dose: 1 g chloroquine phosphate (600 mg base) orally
Second dose (6 hours after first dose): 500 mg chloroquine phosphate (300 mg base) orally
Third dose (24 hours after first dose): 500 mg chloroquine phosphate (300 mg base) orally
Fourth dose (36 hours after first dose): 500 mg chloroquine phosphate (300 mg base) orally
Total dose: 2.5 g chloroquine phosphate (1.5 g base) in 3 days

Comments:
-Concomitant therapy with an 8-aminoquinoline compound is necessary for radical cure of malaria due to P vivax and P malariae.

Approved indication: For acute attacks of malaria due to P vivax, P malariae, P ovale, and susceptible strains of P falciparum

CDC Recommendations:
Chloroquine-sensitive uncomplicated malaria (Plasmodium species or species not identified): 10 mg base/kg orally at once, followed by 5 mg base/kg orally at 6, 24, and 48 hours
Total dose: 25 mg base/kg

Comments:
-Pediatric dose should never exceed adult dose.
-For the treatment of uncomplicated malaria due to chloroquine-sensitive P vivax or P ovale, concomitant treatment with primaquine phosphate is recommended.
-Current guidelines should be consulted for additional information.

What other drugs will affect chloroquine?

Tell your doctor about all other medicines you use, especially:

  • cimetidine (Tagamet);

  • cyclosporine (Gengraf, Neoral, Sandimmune);

  • mefloquine (Lariam);

  • an antibiotic, antifungal medicine, sulfa drug, or tuberculosis medicine;

  • birth control pills or hormone replacement therapy;

  • blood pressure medication;

  • cancer medication;

  • cholesterol-lowering medications such as Lipitor, Niaspan, Zocor, Vytorin, and others;

  • gout or arthritis medications (including gold injections);

  • HIV/AIDS medications;

  • medicines to treat psychiatric disorders;

  • an NSAID such as Advil, Aleve, Arthrotec, Cataflam, Celebrex, Indocin, Motrin, Naprosyn, Treximet, Voltaren, and others; or

  • seizure medications.

This list is not complete and other drugs may interact with chloroquine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about chloroquine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 4.01. Revision Date: 2012-09-12, 1:57:39 PM.

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