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hydroxychloroquine sulfate (Rx)Brand and Other Names:Plaquenil

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 200mg
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Malaria

Plasmodium malariae, P ovale, P vivax, or susceptible strains of P falciparum

Acute treatment

  • 800 mg (620 mg base) PO, then 400 mg (310 mg base) PO 6-8 hours later, then 400 mg (310 mg base) PO at 24 and 48 hours 

Prophylaxis

  • 400 mg (310 mg base) PO weekly, starting 2 weeks before exposure and continued for 4 weeks after departure from area
  • With prolonged therapy, obtain CBCs periodically 

Rheumatoid Arthritis

400-600 mg (310-465 mg base) PO daily for 4-12 weeks; maintenance: 200-400 mg (155-310 mg base) PO daily

With prolonged therapy, obtain CBCs periodically

Systemic Lupus Erythematosus

400 mg (310 mg base) PO once or twice daily; maintenance: 200-400 mg (155-310 mg base) PO daily

With prolonged therapy, obtain CBCs periodically

Porphyria Cutanea Tarda (Off-label)

100-200 mg (77.5-155 mg base) PO 2-3 times/wk

Administration

Take with food or milk

Dosage Forms & Strengths

tablet

  • 200mg
more...

Malaria

Plasmodium malariae, P ovale, P vivax, or susceptible strains of P falciparum 

Acute treatment

  • 13 mg/kg base PO, then 6.5 mg/kg base PO 6 hr later, then 6.5 mg/kg base PO at 24 and 48 hours; not to exceed 400 mg/day base  

Prophylaxis

  • 6.5 mg/kg base (not to exceed 400 mg [310 mg base]) PO weekly, starting 2 weeks before exposure and continued for 4 weeks after departure from area
  • With prolonged therapy, obtain CBCs periodically

Porphyria Cutanea Tarda (Off-label)

Dosing schedules not well established in children

A case report describes 3 mg/kg PO twice weekly over 14 months reported as safe and effective in a child aged 4 yr

Administration

Take with food or milk

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Interactions

Interaction Checker

hydroxychloroquine sulfate and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Nausea, vomiting

            Headache

            Dizziness

            Irritability

            Muscle weakness

            Aplastic anemia

            Leukopenia

            Thrombocytopenia

            Corneal changes or deposits (visual disturbances, blurred vision, photophobia; reversible on discontinuance)

            Retinal damage with long-term use

            Bleaching of hair

            Alopecia

            Pruritus

            Skin and musculoskeletal pigmentation changes

            Weight loss, anorexia

            Cardiomyopathy (rare)

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            Warnings

            Black Box Warnings

            Should be prescribed by experienced physician familiar with complete contents of package insert

            Contraindications

            Hypersensitivity to 4-aminoquinoline derivatives

            Retinal or visual field changes due to 4-aminoquinoline compounds

            Long-term therapy in children

            Cautions

            Discontinue in 6 months if improvement is inadequate

            Exacerbates psoriasis and porphyria; use with caution

            Retinal damage and loss of visual acuity may occur with long-term use; perform periodic ophthalmologic examinations

            Hepatic disease or alcoholism

            Glucose-6-phosphate dehydrogenase (G6PD) deficiency is associated with hemolysis and renal impairment; use with caution

            Patients are prone to dermatitis outbreaks

            Cardiomyopathy (rare) is reported with long-term use

            Hematologic reactions (including aplastic anemia) and agranulocytosis may occur

            Myopathy and neuromyopathy and muscle weakness are associated with aminoquinolone derivatives; assess muscle strength periodically

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Drug is concentrated in breast milk (American Academy of Pediatrics committee states that it is compatible with nursing)

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Unknown; may impair complement-dependent antigen-antibody reactions; inhibits locomotion of neutrophils and chemotaxis of eosinophils

            Increases pH and interferes with lysosomal degradation of hemoglobin, which in turn interferes with digestive vacuole function

            Absorption

            Bioavailability: Rapid and complete absorption

            Onset: May take 4-6 months to show response; peak response takes several months (rheumatic disease) 

            Duration: Unknown

            Peak plasma time: 1-3 hr

            Distribution

            Protein bound: 55%

            Metabolism

            Metabolites: Desethylhydroxychloroquine, desethylchloroquine

            Elimination

            Half-life: 32-50 days

            Excretion: Urine (60%)

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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