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hydroxychloroquine

Pronunciation

Generic Name: hydroxychloroquine (hye drox ee KLOR oh kwin)
Brand Name: Plaquenil Sulfate, Quineprox, Plaquenil

What is hydroxychloroquine?

Hydroxychloroquine is used to treat or prevent malaria, a disease caused by parasites that enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia.

Hydroxychloroquine is also used to treat symptoms of rheumatoid arthritis and discoid or systemic lupus erythematosus.

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

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

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

Before using hydroxychloroquine, tell your doctor if you are allergic to any drugs, or if you have psoriasis, porphyria, liver disease, alcoholism, or glucose-6-phosphate dehydrogenase (G-6-PD) deficiency.

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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 hydroxychloroquine can be fatal, especially in children.

Take this medicine for the full prescribed length of time for malaria. Your symptoms may improve before the infection is completely cleared.

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.

When treating lupus or arthritis, tell your doctor if your symptoms do not improve after 6 months of treatment.

While using hydroxychloroquine, you may need frequent blood tests at your doctor's office.

What should I discuss with my health care provider before taking hydroxychloroquine?

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

Hydroxychloroquine should not be used for long-term treatment in children.

To make sure hydroxychloroquine is safe for you, tell your doctor if you have any of these conditions:

  • psoriasis;

  • porphyria;

  • liver disease;

  • alcoholism; or

  • glucose-6-phosphate dehydrogenase (G-6-PD) deficiency.

It is not known whether hydroxychloroquine 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 hydroxychloroquine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take hydroxychloroquine?

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.

Take hydroxychloroquine with a meal or a glass of milk, unless your doctor tells you otherwise.

Hydroxychloroquine 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.

To treat malaria: Your doctor may recommend a single dose, or a high starting dose followed by a smaller dose during the last 2 days of treatment. Follow your doctor's instructions.

Take this medicine for the full prescribed length of time for malaria. Your symptoms may improve before the infection is completely cleared.

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

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.

When treating lupus or arthritis, hydroxychloroquine is usually given daily for several weeks or months. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 6 months of treatment.

While using hydroxychloroquine, you may need frequent blood tests at your doctor's office.

No medication is 100% effective in treating or preventing all types of malaria. For best results, keep using the medication as directed. Talk with your doctor if you have fever, vomiting, or diarrhea during your treatment.

Store at room temperature away from moisture, heat, and light.

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 hydroxychloroquine can be fatal, especially in children.

Treatment of a hydroxychloroquine 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 a hydroxychloroquine overdose.

Overdose symptoms may include headache, drowsiness, vision changes, slow heart rate, chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, seizure (convulsions), shallow breathing, or breathing that stops.

What should I avoid while taking hydroxychloroquine?

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

Hydroxychloroquine 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 hydroxychloroquine 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; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • muscle weakness, twitching, or uncontrolled movement;

  • loss of balance or coordination;

  • blurred vision, light sensitivity, seeing halos around lights;

  • pale skin, easy bruising or bleeding;

  • confusion, unusual thoughts or behavior; or

  • seizure (convulsions).

Less serious side effects may include:

  • headache, ringing in your ears, spinning sensation;

  • nausea, vomiting, stomach pain;

  • loss of appetite, weight loss;

  • mood changes, feeling nervous or irritable;

  • skin rash or itching; or

  • hair loss.

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)

Hydroxychloroquine dosing information

Usual Adult Dose for Malaria:

Treatment of the acute attack: 800 mg (620 mg base) followed in 6 to 8 hours by 400 mg (310 mg base), then 400 mg (310 mg base) once a day for 2 consecutive days; alternatively, a single dose of 800 mg (620 mg base) has also been effective

Dosage on the basis of body weight:
First dose: 10 mg base/kg (not to exceed 620 mg base)
Second dose: 5 mg base/kg (not to exceed 310 mg base) 6 hours after first dose
Third dose: 5 mg base/kg 18 hours after second dose
Fourth dose: 5 mg base/kg 24 hours after third dose

Each dose should be taken with a meal or a glass of milk.

Concomitant therapy with an 8-aminoquinoline drug is necessary for the radical cure of vivax and malariae malaria.

Usual Adult Dose for Malaria Prophylaxis:

Suppression: 400 mg (310 mg base) orally on the same day every week

Suppressive therapy should begin 2 weeks prior to exposure; however, failing this, an initial dose of 800 mg (620 mg base) may be taken in 2 divided doses (6 hours apart). Suppressive therapy should continue for 8 weeks after leaving the endemic area.

Each dose should be taken with a meal or a glass of milk.

Usual Adult Dose for Rheumatoid Arthritis:

Initial dose: 400 to 600 mg (310 to 465 mg base) orally once a day
Maintenance dose: 200 to 400 mg (155 to 310 mg base) orally once a day

Each dose should be taken with a meal or a glass of milk.

Usual Adult Dose for Systemic Lupus Erythematosus:

Discoid and systemic lupus erythematosus:
Initial dose: 400 mg (310 mg base) orally once or twice a day for several weeks or months, depending on patient response
Maintenance dose: 200 to 400 mg (155 to 310 mg base) orally once a day

Each dose should be taken with a meal or a glass of milk.

Usual Pediatric Dose for Malaria:

Treatment of the acute attack:
1 year or older:
First dose: 10 mg base/kg (not to exceed 620 mg base)
Second dose: 5 mg base/kg (not to exceed 310 mg base) 6 hours after first dose
Third dose: 5 mg base/kg 18 hours after second dose
Fourth dose: 5 mg base/kg 24 hours after third dose

Each dose should be taken with a meal or a glass of milk.

Concomitant therapy with an 8-aminoquinoline drug is necessary for the radical cure of vivax and malariae malaria.

Usual Pediatric Dose for Malaria Prophylaxis:

Suppression:
1 year or older: 5 mg base/kg of body weight (not to exceed 310 mg base) orally on the same day every week

Suppressive therapy should begin 2 weeks prior to exposure; however, failing this, an initial dose of 10 mg base/kg (not to exceed 620 mg base) may be taken in 2 divided doses (6 hours apart). Suppressive therapy should continue for 8 weeks after leaving the endemic area.

Each dose should be taken with a meal or a glass of milk.

Usual Pediatric Dose for Dermatomyositis:

Case Review (n=25)
Juvenile Dermatomyositis (JDMS):
1.5 to 15 years: 7 mg/kg orally per day (added to first course treatment for JDMS if the patient presented with extensive skin rash and needed steroids in high doses)

Each dose should be taken with a meal or a glass of milk.

What other drugs will affect hydroxychloroquine?

Hydroxychloroquine can harm your liver. This effect is increased when you also use other medicines harmful to the liver. You may need dose adjustments or special tests if you have recently used:

  • acetaminophen (Tylenol);

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

  • birth control pills or hormone replacement therapy;

  • blood pressure medication;

  • cancer medications;

  • cholesterol-lowering medications such as Crestor, Lipitor, Pravachol, Simcor, Vytorin, Zocor;

  • 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; or

  • seizure medications.

This list is not complete and other drugs may interact with hydroxychloroquine. 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 hydroxychloroquine.
  • 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: 7.01. Revision Date: 2012-11-13, 3:35:03 PM.

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