Hydroxychloroquine Sulphate

Hydroxychloroquine Sulphate is a Disease Modifying Anti-Rheumatoid Drug (DMARD) used in the treatment of autoimmune conditions such as rheumatoid arthritis and systemic lupus erythematosus. It suppresses the overactivity of the immune system that causes inflammation and pain in the joints, slowing the progression of the underlying disease. It is also used in the treatment and prophylaxis of malaria.

• Acute and chronic rheumatoid arthritis
• Systemic Lupus Erythematosus (SLE)
• Malaria

Adult Dose (Oral):

• Rheumatoid Arthritis: 400-600 mg daily (4-12 weeks); maintenance: 200-400 mg daily
• SLE: 400 mg once or twice daily; maintenance: 200-400 mg daily
• Malaria (Acute): 800 mg, then 400 mg 6-8 hours later, then 400 mg at 24 and 48 hours
• Malaria (Prophylaxis): 400 mg weekly (start 2 weeks before exposure, continue 4 weeks after departure)

Child Dose (Oral):

• Malaria (Acute): 13 mg base/kg, then 6.5 mg base/kg 6 hr later, then 6.5 mg base/kg at 24 and 48 hours; max 400 mg base/day
• Malaria (Prophylaxis): 6.5 mg base/kg weekly (max 400 mg), start 2 weeks before exposure, continue 4 weeks after departure

Common Side Effects:

• Blurred vision
• Abdominal pain
• Nausea
• Vomiting
• Diarrhea
• Headache
• Skin rash
• Loss of appetite
• Mood changes
• Tiredness, weakness

Precautions:

• Hydroxychloroquine Sulphate may affect your ability to drive (eye problems may occur)
• It can take 8-12 weeks to work
• Have regular eye tests done (ophthalmologic examination every 12 months)
• Stop and inform doctor immediately if you notice vision changes
• Can lower blood glucose levels; inform doctor if hypoglycemia symptoms occur
• Inform doctor if pregnant, planning pregnancy or breastfeeding
• Children are especially sensitive to 4-aminoquinoline compounds

Contraindications:

• Retinal or visual field changes due to any 4-aminoquinoline compound
• Known hypersensitivity to 4-aminoquinoline compounds
• Long term therapy in children

Drug Interactions:

• Cimetidine may increase serum levels of hydroxychloroquine
• Kaolin or Mg trisilicate may decrease absorption
• Avoid digoxin and alcohol
• Increased risk of ventricular arrhythmias with halofantrine
• Increased risk of convulsions with mefloquine
• May interact with digoxin, insulin or antidiabetic drugs, mefloquine, antiepileptics, methotrexate and cyclosporine

Food Interactions: Caution is advised when consuming alcohol with Hydroxychloroquine Sulphate; consult your doctor.

Use in Pregnancy: May be unsafe; animal studies have shown harmful effects; use only if clearly needed.

Use in Lactation: Safe during breastfeeding; does not pass into breastmilk in significant amount and is not harmful to baby.

Renal Impairment: Caution in kidney disease; dose adjustment may be needed; estimate plasma levels in severely compromised function.

Hepatic Impairment: Caution in liver disease; dose adjustment may be needed; estimate plasma levels in severely compromised function.

Overdose: Headache, drowsiness, visual disturbances, cardiovascular collapse and convulsions, followed by respiratory and cardiac arrest; gastric lavage until stomach is completely emptied.