Dosing & Uses
Dosage Forms & Strengths
tablet
- 200mg
Malaria
Prophylaxis
- Indicated for prophylaxis of malaria in geographic areas where chloroquine resistance is not reported
- 400 mg (310 mg base) PO weekly, starting 2 weeks before exposure and continued for 4 weeks after departure from endemic area OR
- Weight-based dosing: 6.5 mg/kg (5 mg/kg base) PO once weekly, not to exceed 400 mg (310 mg base), starting 2 weeks before exposure and continued for 4 weeks after leaving the endemic area
Acute treatment
- Indicated for treatment of uncomplicated malaria due to P falciparum, P malariae, P ovale, and P vivax
- 800 mg (620 mg base) PO, then 400 mg (310 mg base) PO at 6 hr, 24 hr, and 48 hr after initial dose
- Weight-based dosing: 13 mg/kg (10 mg/kg base), not to exceed 800 mg (620 mg base) followed by 6.5 mg/kg (5 mg/kg base), not to exceed 400 mg (310 mg base), PO at 6 hr, 24 hr, and 48 hr after initial dose
Rheumatoid Arthritis
Indicated for treatment of acute and chronic rheumatoid arthritis
400-600 mg/day (310-465 mg base/day) PO as a qDay or in BID
When a good response is obtained, reduce dosage by 50% and continue maintenance dose of 200-400 mg/day (155-310 mg base/day) PO as a qDay or in BID; not exceed 600 mg or 6.5 mg/kg (5 mg/kg base) per day, whichever is lower, as the incidence of retinopathy has been reported to be higher when this maintenance dose is exceeded
Use corticosteroids and salicylates in conjunction with hydroxychloroquine; gradually decrease dosage or eliminate after a maintenance dose has been achieved
Systemic Lupus Erythematosus
Indicated for treatment of chronic discoid lupus erythematosus and systemic lupus erythematosus
200-400 mg/day (155-310 mg base/day) PO as a single daily dose or in two divided doses
Doses >400 mg/day are not recommended
Incidence of retinopathy has been reported to be higher when this maintenance dose is exceeded
Coronavirus Disease 2019 (COVID-19) (Off-label)
FDA revoked the emergency use authorization (EUA) for hydroxychloroquine on June 15, 2020
Based on its ongoing analysis of the EUA and emerging scientific data, the FDA determined that hydroxychloroquine is unlikely to be effective in treating COVID-19 for the authorized uses in the EUA; additionally, in light of ongoing serious cardiac adverse events and other potential serious side effects, the known and potential benefits of hydroxychloroquine no longer outweigh the known and potential risks for the EUA
While additional clinical trials may continue to evaluate potential benefit, the FDA determined the EUA was no longer appropriate
The NIH COVID-19 Treatment Guidelines recommend against the use of chloroquine or hydroxychloroquine and/or azithromycin for the treatment of COVID-19 in hospitalized patients and in nonhospitalized patients
For more information, see the FDA news release: FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine
Additional Medscape COVID-19 references are available
- Coronavirus Disease 2019 (COVID-19) (link https://emedicine.medscape.com/article/2500114-overview)
- Novel Coronavirus Resource Center (link https://www.medscape.com/resource/coronavirus)
Porphyria Cutanea Tarda (Off-label)
100-200 mg (77.5-155 mg base) PO 2-3 times/wk
Dosing Considerations
A reduction in dosage may be necessary for patients with hepatic or renal disease
Before prescribing hydroxychloroquine for treatment or prophylaxis of malaria, consult the Centers for Disease Control and Prevention (CDC) Malaria website (link http://www.cdc.gov/malaria)
Limitations of use in malaria
- Not recommended for treatment of complicated malaria
- Not effective against chloroquine or hydroxychloroquine-resistant strains of Plasmodium species
- Not recommended for treatment of malaria acquired in geographic areas where chloroquine resistance occurs or when the Plasmodium species has not been identified
- Not recommended for malaria prophylaxis in geographic areas where chloroquine resistance occurs
- Does not prevent relapses of P vivax or P ovale because it is not active against the hypnozoite forms of these parasites
- For radical cure of P vivax and P ovale infections, concomitant therapy with an 8-aminoquinoline compound is necessary
Dosage Forms & Strengths
tablet
- 200mg
Malaria
Prophylaxis
- Indicated for prophylaxis of malaria in geographic areas where chloroquine resistance is not reported.
- 6.5 mg/kg (5 mg/kg base) PO once weekly, not to exceed 400 mg (310 mg base), starting 2 weeks before exposure and continued for 4 weeks after leaving the endemic area
Acute treatment
- Indicated for treatment of uncomplicated malaria due to P falciparum, P malariae, P ovale, and P vivax
- 13 mg/kg (10 mg/kg base), not to exceed 800 mg (620 mg base) followed by 6.5 mg/kg (5 mg/kg base), not to exceed 400 mg (310 mg base), PO at 6 hr, 24 hr, and 48 hr after initial dose
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
Dosing Considerations
Before to prescribing hydroxychloroquine for treatment or prophylaxis of malaria, consult the Centers for Disease Control and Prevention (CDC) Malaria website (link http://www.cdc.gov/malaria)
Limitations of use in malaria
- Not recommended for treatment of complicated malaria
- Not effective against chloroquine or hydroxychloroquine-resistant strains of Plasmodium species
- Not recommended for treatment of malaria acquired in geographic areas where chloroquine resistance occurs or when the Plasmodium species has not been identified
- Not recommended for malaria prophylaxis in geographic areas where chloroquine resistance occurs
- Does not prevent relapses of P vivax or P ovale because it is not active against the hypnozoite forms of these parasites
- For radical cure of P vivax and P ovale infections, concomitant therapy with an 8-aminoquinoline compound is necessary
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- lefamulin
lefamulin will increase the level or effect of hydroxychloroquine sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.
Serious - Use Alternative (211)
- adagrasib
adagrasib, hydroxychloroquine sulfate. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.
- adalimumab
adalimumab and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- albuterol
albuterol and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- alefacept
alefacept and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- alfuzosin
hydroxychloroquine sulfate and alfuzosin both increase QTc interval. Avoid or Use Alternate Drug.
alfuzosin and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug. - amiodarone
hydroxychloroquine sulfate and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
- amisulpride
amisulpride and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
- amitriptyline
hydroxychloroquine sulfate and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- amoxapine
hydroxychloroquine sulfate and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.
- anagrelide
anagrelide and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- anakinra
anakinra and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- anthrax vaccine
hydroxychloroquine sulfate decreases effects of anthrax vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- antithymocyte globulin equine
antithymocyte globulin equine and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- antithymocyte globulin rabbit
antithymocyte globulin rabbit and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- apomorphine
hydroxychloroquine sulfate and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.
- arformoterol
hydroxychloroquine sulfate and arformoterol both increase QTc interval. Avoid or Use Alternate Drug.
- aripiprazole
aripiprazole and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- arsenic trioxide
hydroxychloroquine sulfate and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
artemether and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- artemether/lumefantrine
hydroxychloroquine sulfate and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine
hydroxychloroquine sulfate and asenapine both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine transdermal
asenapine transdermal and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- atomoxetine
atomoxetine and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- axicabtagene ciloleucel
hydroxychloroquine sulfate, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- azathioprine
azathioprine and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- azithromycin
hydroxychloroquine sulfate and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.
- basiliximab
basiliximab and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- BCG vaccine live
hydroxychloroquine sulfate decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- bedaquiline
hydroxychloroquine sulfate and bedaquiline both increase QTc interval. Avoid or Use Alternate Drug.
- brexucabtagene autoleucel
hydroxychloroquine sulfate, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- buprenorphine
buprenorphine and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine transdermal
buprenorphine transdermal and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- canakinumab
canakinumab and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- ceritinib
ceritinib and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- chlorpromazine
hydroxychloroquine sulfate and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.
- ciltacabtagene autoleucel
hydroxychloroquine sulfate, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- ciprofloxacin
hydroxychloroquine sulfate and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- cisapride
hydroxychloroquine sulfate increases toxicity of cisapride by QTc interval. Avoid or Use Alternate Drug.
- citalopram
hydroxychloroquine sulfate and citalopram both increase QTc interval. Avoid or Use Alternate Drug.
- clarithromycin
hydroxychloroquine sulfate and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.
- clofazimine
hydroxychloroquine sulfate and clofazimine both increase QTc interval. Avoid or Use Alternate Drug.
- clomipramine
hydroxychloroquine sulfate and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.
- clozapine
hydroxychloroquine sulfate and clozapine both increase QTc interval. Avoid or Use Alternate Drug.
- crizotinib
hydroxychloroquine sulfate and crizotinib both increase QTc interval. Avoid or Use Alternate Drug.
- dapsone topical
hydroxychloroquine sulfate, dapsone topical. unspecified interaction mechanism. Avoid or Use Alternate Drug. Avoid coadministration of dapsone topical with oral dapsone or antimalarial medications because of the potential for hemolytic reactions.
- dasatinib
hydroxychloroquine sulfate and dasatinib both increase QTc interval. Avoid or Use Alternate Drug.
- degarelix
hydroxychloroquine sulfate and degarelix both increase QTc interval. Avoid or Use Alternate Drug.
- desflurane
desflurane and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- desipramine
hydroxychloroquine sulfate and desipramine both increase QTc interval. Avoid or Use Alternate Drug.
- digoxin
hydroxychloroquine sulfate increases levels of digoxin by unknown mechanism. Avoid or Use Alternate Drug.
- diphtheria & tetanus toxoids
hydroxychloroquine sulfate decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- diphtheria & tetanus toxoids/ acellular pertussis vaccine
hydroxychloroquine sulfate decreases effects of diphtheria & tetanus toxoids/ acellular pertussis vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine
hydroxychloroquine sulfate decreases effects of diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- disopyramide
hydroxychloroquine sulfate and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- dofetilide
hydroxychloroquine sulfate and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
dofetilide increases toxicity of hydroxychloroquine sulfate by QTc interval. Avoid or Use Alternate Drug. - dolasetron
hydroxychloroquine sulfate and dolasetron both increase QTc interval. Avoid or Use Alternate Drug.
- donepezil
donepezil and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- doxepin
doxepin and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- dronedarone
hydroxychloroquine sulfate and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.
- droperidol
hydroxychloroquine sulfate and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
- efavirenz
efavirenz and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- eliglustat
eliglustat and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.
hydroxychloroquine sulfate and encorafenib both increase QTc interval. Avoid or Use Alternate Drug. - entrectinib
hydroxychloroquine sulfate and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
- eribulin
hydroxychloroquine sulfate and eribulin both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin base
hydroxychloroquine sulfate and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin ethylsuccinate
hydroxychloroquine sulfate and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin lactobionate
hydroxychloroquine sulfate and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin stearate
hydroxychloroquine sulfate and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
- escitalopram
hydroxychloroquine sulfate and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.
escitalopram increases toxicity of hydroxychloroquine sulfate by QTc interval. Avoid or Use Alternate Drug. - etanercept
etanercept and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- everolimus
everolimus and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- ezogabine
hydroxychloroquine sulfate and ezogabine both increase QTc interval. Avoid or Use Alternate Drug.
- fexinidazole
fexinidazole and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
- fingolimod
fingolimod and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- flecainide
hydroxychloroquine sulfate and flecainide both increase QTc interval. Avoid or Use Alternate Drug.
- fluconazole
hydroxychloroquine sulfate and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.
- fluoxetine
hydroxychloroquine sulfate and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.
- fluphenazine
hydroxychloroquine sulfate and fluphenazine both increase QTc interval. Avoid or Use Alternate Drug.
- formoterol
hydroxychloroquine sulfate and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
- foscarnet
hydroxychloroquine sulfate and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.
- gemifloxacin
hydroxychloroquine sulfate and gemifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- gemtuzumab
hydroxychloroquine sulfate and gemtuzumab both increase QTc interval. Avoid or Use Alternate Drug.
- gilteritinib
gilteritinib and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- glasdegib
hydroxychloroquine sulfate and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.
- glatiramer
glatiramer and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- golimumab
golimumab and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- granisetron
granisetron and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- haloperidol
hydroxychloroquine sulfate and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.
- hepatitis A vaccine inactivated
hydroxychloroquine sulfate decreases effects of hepatitis A vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- hepatitis a/b vaccine
hydroxychloroquine sulfate decreases effects of hepatitis a/b vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- hepatitis a/typhoid vaccine
hydroxychloroquine sulfate decreases effects of hepatitis a/typhoid vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- hepatitis b vaccine
hydroxychloroquine sulfate decreases effects of hepatitis b vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- human papillomavirus vaccine, nonavalent
hydroxychloroquine sulfate decreases effects of human papillomavirus vaccine, nonavalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.
- human papillomavirus vaccine, quadrivalent
hydroxychloroquine sulfate decreases effects of human papillomavirus vaccine, quadrivalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.
- hydroxyzine
hydroxyzine and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- ibutilide
hydroxychloroquine sulfate and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.
- idecabtagene vicleucel
hydroxychloroquine sulfate, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- iloperidone
hydroxychloroquine sulfate and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.
- indacaterol, inhaled
hydroxychloroquine sulfate and indacaterol, inhaled both increase QTc interval. Avoid or Use Alternate Drug.
- indapamide
hydroxychloroquine sulfate and indapamide both increase QTc interval. Avoid or Use Alternate Drug.
- infliximab
hydroxychloroquine sulfate and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- influenza virus vaccine quadrivalent, cell-cultured
hydroxychloroquine sulfate decreases effects of influenza virus vaccine quadrivalent, cell-cultured by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- influenza virus vaccine quadrivalent, intranasal
hydroxychloroquine sulfate decreases effects of influenza virus vaccine quadrivalent, intranasal by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- influenza virus vaccine trivalent
hydroxychloroquine sulfate decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- inotuzumab
hydroxychloroquine sulfate and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.
- isoflurane
isoflurane and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- isradipine
hydroxychloroquine sulfate and isradipine both increase QTc interval. Avoid or Use Alternate Drug.
- itraconazole
itraconazole and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- Japanese encephalitis virus vaccine
hydroxychloroquine sulfate decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- lapatinib
hydroxychloroquine sulfate and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.
- leflunomide
hydroxychloroquine sulfate and leflunomide both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- levofloxacin
hydroxychloroquine sulfate and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- lisocabtagene maraleucel
hydroxychloroquine sulfate, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- lithium
lithium and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- lofexidine
hydroxychloroquine sulfate and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.
- lopinavir
hydroxychloroquine sulfate and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.
- maprotiline
hydroxychloroquine sulfate and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
- measles (rubeola) vaccine
hydroxychloroquine sulfate decreases effects of measles (rubeola) vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- measles mumps and rubella vaccine, live
hydroxychloroquine sulfate decreases effects of measles mumps and rubella vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- measles, mumps, rubella and varicella vaccine, live
hydroxychloroquine sulfate decreases effects of measles, mumps, rubella and varicella vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- mefloquine
hydroxychloroquine sulfate and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.
- meningococcal A C Y and W-135 polysaccharide vaccine combined
hydroxychloroquine sulfate decreases effects of meningococcal A C Y and W-135 polysaccharide vaccine combined by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- methadone
hydroxychloroquine sulfate and methadone both increase QTc interval. Avoid or Use Alternate Drug.
- mifepristone
hydroxychloroquine sulfate and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- mirtazapine
mirtazapine and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- mobocertinib
mobocertinib and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.
- moxifloxacin
hydroxychloroquine sulfate and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- muromonab CD3
hydroxychloroquine sulfate and muromonab CD3 both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- mycophenolate
hydroxychloroquine sulfate and mycophenolate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- nilotinib
hydroxychloroquine sulfate and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
- nortriptyline
hydroxychloroquine sulfate and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- octreotide
hydroxychloroquine sulfate and octreotide both increase QTc interval. Avoid or Use Alternate Drug.
- ofloxacin
hydroxychloroquine sulfate and ofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- olanzapine
hydroxychloroquine sulfate and olanzapine both increase QTc interval. Avoid or Use Alternate Drug.
- ondansetron
hydroxychloroquine sulfate and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.
- osimertinib
hydroxychloroquine sulfate and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.
- oxaliplatin
oxaliplatin and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- paliperidone
hydroxychloroquine sulfate and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- panobinostat
hydroxychloroquine sulfate and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.
- pasireotide
hydroxychloroquine sulfate and pasireotide both increase QTc interval. Avoid or Use Alternate Drug.
- pazopanib
hydroxychloroquine sulfate and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.
- pentamidine
hydroxychloroquine sulfate and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- perphenazine
hydroxychloroquine sulfate and perphenazine both increase QTc interval. Avoid or Use Alternate Drug.
- pimavanserin
hydroxychloroquine sulfate and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.
- pimozide
hydroxychloroquine sulfate and pimozide both increase QTc interval. Avoid or Use Alternate Drug.
- pitolisant
hydroxychloroquine sulfate and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.
- pneumococcal vaccine 13-valent
hydroxychloroquine sulfate decreases effects of pneumococcal vaccine 13-valent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- pneumococcal vaccine heptavalent
hydroxychloroquine sulfate decreases effects of pneumococcal vaccine heptavalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- pneumococcal vaccine polyvalent
hydroxychloroquine sulfate decreases effects of pneumococcal vaccine polyvalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- posaconazole
hydroxychloroquine sulfate and posaconazole both increase QTc interval. Avoid or Use Alternate Drug.
- primaquine
primaquine and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- procainamide
hydroxychloroquine sulfate increases toxicity of procainamide by QTc interval. Avoid or Use Alternate Drug.
- propafenone
hydroxychloroquine sulfate and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- protriptyline
hydroxychloroquine sulfate and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.
- quetiapine
hydroxychloroquine sulfate and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.
- quinidine
hydroxychloroquine sulfate and quinidine both increase QTc interval. Avoid or Use Alternate Drug.
- quinine
hydroxychloroquine sulfate and quinine both increase QTc interval. Avoid or Use Alternate Drug.
- rabies vaccine
hydroxychloroquine sulfate decreases effects of rabies vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants may interfere with development of active immunity.
- rabies vaccine chick embryo cell derived
hydroxychloroquine sulfate decreases effects of rabies vaccine chick embryo cell derived by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- ranolazine
hydroxychloroquine sulfate and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.
- remdesivir
hydroxychloroquine sulfate decreases effects of remdesivir by unspecified interaction mechanism. Avoid or Use Alternate Drug. Coadministration not recommended owing to antagonistic effect on remdesivir?s intracellular metabolic activation and antiviral activity.
- ribociclib
hydroxychloroquine sulfate and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.
ribociclib increases toxicity of hydroxychloroquine sulfate by QTc interval. Avoid or Use Alternate Drug. - rilonacept
hydroxychloroquine sulfate and rilonacept both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- rilpivirine
hydroxychloroquine sulfate and rilpivirine both increase QTc interval. Avoid or Use Alternate Drug.
- risperidone
hydroxychloroquine sulfate and risperidone both increase QTc interval. Avoid or Use Alternate Drug.
- ritonavir
hydroxychloroquine sulfate and ritonavir both increase QTc interval. Avoid or Use Alternate Drug.
- romidepsin
hydroxychloroquine sulfate and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.
- rotavirus oral vaccine, live
hydroxychloroquine sulfate decreases effects of rotavirus oral vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- rubella vaccine
hydroxychloroquine sulfate decreases effects of rubella vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- saquinavir
hydroxychloroquine sulfate and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.
- sertraline
hydroxychloroquine sulfate and sertraline both increase QTc interval. Avoid or Use Alternate Drug.
- sevoflurane
sevoflurane and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- siponimod
siponimod and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- sirolimus
hydroxychloroquine sulfate and sirolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- smallpox (vaccinia) vaccine, live
hydroxychloroquine sulfate decreases effects of smallpox (vaccinia) vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- solifenacin
hydroxychloroquine sulfate and solifenacin both increase QTc interval. Avoid or Use Alternate Drug.
- sorafenib
hydroxychloroquine sulfate and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.
- sotalol
hydroxychloroquine sulfate and sotalol both increase QTc interval. Avoid or Use Alternate Drug.
- sunitinib
hydroxychloroquine sulfate and sunitinib both increase QTc interval. Avoid or Use Alternate Drug.
- tacrolimus
hydroxychloroquine sulfate and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
hydroxychloroquine sulfate and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. - telavancin
hydroxychloroquine sulfate and telavancin both increase QTc interval. Avoid or Use Alternate Drug.
- temsirolimus
hydroxychloroquine sulfate and temsirolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- tetanus toxoid adsorbed or fluid
hydroxychloroquine sulfate decreases effects of tetanus toxoid adsorbed or fluid by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- tetrabenazine
hydroxychloroquine sulfate and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- thioridazine
hydroxychloroquine sulfate and thioridazine both increase QTc interval. Avoid or Use Alternate Drug.
- thiothixene
hydroxychloroquine sulfate and thiothixene both increase QTc interval. Avoid or Use Alternate Drug.
- tick-borne encephalitis vaccine
hydroxychloroquine sulfate decreases effects of tick-borne encephalitis vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- tisagenlecleucel
hydroxychloroquine sulfate, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- tocilizumab
tocilizumab and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- tofacitinib
hydroxychloroquine sulfate, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- tongkat ali
hydroxychloroquine sulfate and tongkat ali both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- toremifene
hydroxychloroquine sulfate and toremifene both increase QTc interval. Avoid or Use Alternate Drug.
- travelers diarrhea and cholera vaccine inactivated
hydroxychloroquine sulfate decreases effects of travelers diarrhea and cholera vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- trimipramine
hydroxychloroquine sulfate and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.
- typhoid polysaccharide vaccine
hydroxychloroquine sulfate decreases effects of typhoid polysaccharide vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- typhoid vaccine live
hydroxychloroquine sulfate decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- ustekinumab
hydroxychloroquine sulfate and ustekinumab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- vandetanib
hydroxychloroquine sulfate and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.
- vardenafil
hydroxychloroquine sulfate and vardenafil both increase QTc interval. Avoid or Use Alternate Drug.
- varicella virus vaccine live
hydroxychloroquine sulfate decreases effects of varicella virus vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- vemurafenib
hydroxychloroquine sulfate and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.
- vilanterol/fluticasone furoate inhaled
hydroxychloroquine sulfate and vilanterol/fluticasone furoate inhaled both increase QTc interval. Avoid or Use Alternate Drug.
- voriconazole
hydroxychloroquine sulfate and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.
- vorinostat
hydroxychloroquine sulfate and vorinostat both increase QTc interval. Avoid or Use Alternate Drug.
- yellow fever vaccine
hydroxychloroquine sulfate decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- ziprasidone
hydroxychloroquine sulfate and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
- zoster vaccine live
hydroxychloroquine sulfate decreases effects of zoster vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
Monitor Closely (27)
- astragalus
hydroxychloroquine sulfate increases and astragalus decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bupivacaine implant
hydroxychloroquine sulfate, bupivacaine implant. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.
- cholera vaccine
hydroxychloroquine sulfate decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.
- cyclosporine
hydroxychloroquine sulfate will increase the level or effect of cyclosporine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- dengue vaccine
hydroxychloroquine sulfate decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.
- denosumab
hydroxychloroquine sulfate, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.
- deutetrabenazine
hydroxychloroquine sulfate and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- echinacea
hydroxychloroquine sulfate increases and echinacea decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fostemsavir
hydroxychloroquine sulfate and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- influenza virus vaccine trivalent, recombinant
hydroxychloroquine sulfate decreases effects of influenza virus vaccine trivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.
- isavuconazonium sulfate
hydroxychloroquine sulfate and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.
- maitake
hydroxychloroquine sulfate increases and maitake decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mercaptopurine
hydroxychloroquine sulfate and mercaptopurine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.
- methotrexate
hydroxychloroquine sulfate decreases levels of methotrexate by unknown mechanism. Use Caution/Monitor. Hydroxychloroquine may reduce the renal clearance of methotrexate; the exact mechanism of this interaction is unknown. .
- osilodrostat
osilodrostat and hydroxychloroquine sulfate both increase QTc interval. Use Caution/Monitor.
hydroxychloroquine sulfate and osilodrostat both increase QTc interval. Use Caution/Monitor. - ozanimod
ozanimod and hydroxychloroquine sulfate both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.
ozanimod, hydroxychloroquine sulfate. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration with immunosuppressive therapies may increase the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs in order to avoid unintended additive immunosuppressive effects. - ponesimod
ponesimod and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.
- selpercatinib
selpercatinib increases toxicity of hydroxychloroquine sulfate by QTc interval. Use Caution/Monitor.
- siponimod
siponimod and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.
- sipuleucel-T
hydroxychloroquine sulfate decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of hydroxychloroquine sulfate by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of hydroxychloroquine sulfate by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
- tobramycin inhaled
tobramycin inhaled and hydroxychloroquine sulfate both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity
- ublituximab
ublituximab and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Owing to potential additive immunosuppressive effects, consider duration of effect and mechanism of action of these therapies if coadministered
- valbenazine
valbenazine and hydroxychloroquine sulfate both increase QTc interval. Use Caution/Monitor.
- voclosporin
voclosporin, hydroxychloroquine sulfate. Either increases effects of the other by QTc interval. Use Caution/Monitor.
- zoster vaccine recombinant
hydroxychloroquine sulfate decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.
Minor (2)
- chloroquine
chloroquine increases toxicity of hydroxychloroquine sulfate by QTc interval. Minor/Significance Unknown.
- praziquantel
hydroxychloroquine sulfate increases levels of praziquantel by unspecified interaction mechanism. Minor/Significance Unknown.
Adverse Effects
Frequency Not Defined
Blood and lymphatic system disorders: Bone marrow failure, anemia, aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia; hemolysis reported in individuals with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency
Cardiac disorders: Cardiomyopathy, QT interval prolongation, and ventricular arrhythmias and torsade de pointes
Ear and labyrinth disorders: Vertigo, tinnitus, nystagmus, nerve deafness, deafness
Eye disorders: Irreversible retinopathy with retinal pigmentation changes (bull’s eye appearance), visual field defects (paracentral scotomas) and visual disturbances (visual acuity), maculopathies (macular degeneration), decreased dark adaptation, color vision abnormalities, corneal changes (edema and opacities) including corneal deposition of drug with or without accompanying symptoms (halo around lights, photophobia, blurred vision)
Gastrointestinal disorders: Nausea, vomiting, diarrhea, abdominal pain
General disorders and administration site conditions: Fatigue
Hepatobiliary disorders: Liver function tests abnormal, hepatic failure acute
Immune system disorders: Urticaria, angioedema, bronchospasm
Metabolism and nutrition disorders: Decreased appetite, hypoglycemia, porphyria, weight decreased
Musculoskeletal and connective tissue disorders: Sensorimotor disorder, skeletal muscle myopathy or neuromyopathy leading to progressive weakness and atrophy of proximal muscle groups, depression of tendon reflexes and abnormal nerve conduction
Nervous system disorders: Headache, dizziness, seizure, ataxia and extrapyramidal disorders such as dystonia, dyskinesia, tremor
Psychiatric disorders: Affect/emotional lability, nervousness, irritability, nightmares, psychosis, suicidal behavior
Skin and subcutaneous tissue disorders: Rash, pruritus, pigmentation disorders in skin and mucous membranes, hair color changes, alopecia; dermatitis bullous eruptions including erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS syndrome), photosensitivity, dermatitis exfoliative, acute generalized exanthematous pustulosis (AGEP)
Warnings
Contraindications
Hypersensitivity to 4-aminoquinoline derivatives
Cautions
Not effective against chloroquine-resistant strains of P falciparum
Rare suicidal behavior has been reported
May cause severe hypoglycemia including loss of consciousness that could be life-threatening in patients treated with or without antidiabetic medications; check blood glucose and adjust treatment if necessary
Exercise caution in patients with hepatic disease or alcoholism or in conjunction with known hepatotoxic drugs; a dosage reduction may be necessary in patients with hepatic or renal disease, as well as in those taking medicines known to affect these organs
Antimalarial compounds should be used with caution in patients with hepatic disease or alcoholism or in conjunction with known hepatotoxic drugs; perform periodic blood cell counts if patients are given prolonged therapy; if any severe blood disorder (eg, aplastic anemia, agranulocytosis, leukopenia, thrombocytopenia) appears which is not attributable to the disease under treatment, consider discontinuing treatment
Endomyocardial biopsy showed association of cardiomyopathy with phospholipidosis in absence of inflammation, infiltration, or necrosis; drug-induced phospholipidosis may occur in other organ systems
Correct electrolyte imbalances prior to use; monitor cardiac function as clinically indicated during therapy; discontinue therapy if cardiotoxicity is suspected or demonstrated by tissue biopsy
Use with caution in patients having glucose-6-phosphate dehydrogenase (G-6-PD) deficiency
Dermatologic reactions may occur
Skeletal muscle myopathy or neuropathy
- Skeletal muscle myopathy or neuropathy leading to progressive weakness and atrophy of proximal muscle groups, depressed tendon reflexes, and abnormal nerve conduction, have been reported; muscle and nerve biopsies have shown associated phospholipidosis;
- Assess muscle strength and deep tendon reflexes periodically in patients on long-term therapy; discontinue therapy if muscle or nerve toxicity suspected or demonstrated by tissue biopsy
Renal toxicity
- Proteinuria with or without moderate reduction in glomerular filtration reported with therapy
- Renal biopsy showed phospholipidosis without immune deposits, inflammation, and/or increased cellularity
- Physicians should consider phospholipidosis as a possible cause of renal injury in patients with underlying connective tissue disorders who are receiving therapy
- Discontinue therapy if renal toxicity suspected or demonstrated by tissue biopsy
Cardiac effects
- Postmarketing cases of life-threatening and fatal cardiomyopathy have been reported
- May present with AV block, pulmonary hypertension, sick sinus syndrome or with cardiac complications
- ECG findings include atrioventricular, right or left bundle branch block
- Monitor for signs and symptoms of cardiomyopathy is advised
- If cardiotoxicity is suspected, promptly discontinue treatment
Ocular toxicity
- Irreversible retinal damage observed; significant risk factors for retinal damage include daily doses of hydroxychloroquine sulfate >6.5 mg/kg (5 mg/kg base) of actual body weight, durations of use >5 years, subnormal glomerular filtration, use of some concomitant drug products such as tamoxifen citrate and concurrent macular disease
- Recommend an ocular exam within first year of therapy; baseline exam should include: best corrected distance visual acuity (BCVA), an automated threshold visual field (VF) of the central 10 degrees (with retesting if an abnormality is noted), and spectral domain ocular coherence tomography (SD-OCT)
- In individuals of Asian descent, retinal toxicity may first be noticed outside macula; in patients of Asian descent, perform visual field testing in central 24 degrees instead of central 10 degrees
- Discontinue if ocular toxicity is suspected and closely observe any retinal changes (and visual disturbances) even after cessation of therapy
Drug interaction overview
- Avoid use with other drugs that have potential to prolong QT interval; hydroxychloroquine prolongs QT interval; ventricular arrhythmias and torsades de pointes reported in patients taking hydroxychloroquine
- Concomitant use with hydroxychloroquine and digoxin therapy may result in increased serum digoxin levels: closely monitor serum digoxin levels in patients receiving combined therapy
- May enhance the effects of a hypoglycemic treatment, a decrease in doses of insulin or antidiabetic drugs may be required
- Coadministration with other antimicrobials#antimalarials known to lower the convulsion threshold (eg, mefloquine) may increase the risk of convulsions
- Activity of antiepileptic drugs might be impaired if coadministered with hydroxychloroquine
- An increased plasma cyclosporine level was reported when cyclosporine and hydroxychloroquine were coadministered
Pregnancy & Lactation
Pregnancy
There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to drug during pregnancy; encourage patients to register by contacting 1-877-311-8972
Prolonged clinical experience over decades of use and available data from published epidemiologic and clinical studies with use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal, or fetal outcomes
There are risks to mother and fetus associated with untreated or increased disease activity from malaria, rheumatoid arthritis, and systemic lupus erythematosus in pregnancy
Animal reproduction studies were not conducted with hydroxychloroquine
Clinical considerations
- Malaria during pregnancy increases risk for adverse pregnancy outcomes, including maternal anemia, prematurity, spontaneous abortion, and stillbirth
- Published data on rheumatoid arthritis suggest that increased disease activity is associated with the risk of developing adverse pregnancy outcomes in women with rheumatoid arthritis include preterm delivery (before 37 weeks of gestation), low birth weight (less than 2500 g) infants, and small for gestational age at birth
- Pregnant women with systemic lupus erythematosus, especially those with increased disease activity, are at increased risk of adverse pregnancy outcomes, including spontaneous abortion, fetal death, preeclampsia, preterm birth, and intrauterine growth restriction; passage of maternal auto-antibodies across placenta may result in neonatal illness, including neonatal lupus and congenital heart block
- Embryonic deaths and malformations of anophthalmia and microphthalmia in the offspring have been reported when pregnant rats received large doses of chloroquine
Lactation
Exercise caution when administering hydroxychloroquine to nursing women
Published lactation data report that hydroxychloroquine is present in human milk at low levels; no adverse reactions have been reported in breastfed infants; no retinal toxicity, ototoxicity, cardiotoxicity, or growth and developmental abnormalities observed in children exposed to hydroxychloroquine through breastmilk
There is no information on effect of hydroxychloroquine on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal condition
When administered to nursing women, hydroxychloroquine is excreted in human milk and it is known that infants are extremely sensitive to the toxic effects of 4-aminoquinolines
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.Pharmacology
Mechanism of Action
Malaria
- Precise mechanism of action against Plasmodium is unknown
- Hydroxychloroquine, like chloroquine, is a weak base and may exert its effect by concentrating in the acid vesicles of the parasite and by inhibiting polymerization of heme
- It can also inhibit certain enzymes by its interaction with DNA
Rheumatoid arthritis and systemic lupus erythematosus
- Mechanisms underlying the anti-inflammatory and immunomodulatory effects of hydroxychloroquine are unknown
Absorption
Peak plasma concentration: 129.6 ng/mL (single 200-mg dose)
Peak plasma time: 3.26 hr (single 200-mg dose); 3-4 hr (chronic PO administration)
Metabolism
Metabolites: Desethylhydroxychloroquine, desethylchloroquine
Elimination
Half-life: 40-50 days
Administration
Oral Administration
Take with a meal or a glass of milk
Do not crush or split tablets
Storage
Dispense in a tight, light-resistant container
Keep out of the reach of children
Store at room temperature (20-25ºC [68-77ºF]), allows excursions at 15-30ºC (59-86ºF)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Plaquenil oral - | 200 mg tablet |  | |
| hydroxychloroquine oral - | 200 mg tablet |  | |
| hydroxychloroquine oral - | 200 mg tablet |  | |
| hydroxychloroquine oral - | 200 mg tablet |  | |
| hydroxychloroquine oral - | 200 mg tablet |  | |
| hydroxychloroquine oral - | 200 mg tablet |  | |
| hydroxychloroquine oral - | 200 mg tablet | | |
| hydroxychloroquine oral - | 200 mg tablet |  | |
| hydroxychloroquine oral - | 200 mg tablet |  | |
| hydroxychloroquine oral - | 200 mg tablet |  | |
| hydroxychloroquine oral - | 200 mg tablet |  | |
| hydroxychloroquine oral - | 200 mg tablet |  | |
| hydroxychloroquine oral - | 200 mg tablet |  | |
| hydroxychloroquine oral - | 200 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
hydroxychloroquine oral
HYDROXYCHLOROQUINE - ORAL
(hi-DROX-ee-KLOR-oh-kwin)
COMMON BRAND NAME(S): Plaquenil
USES: Hydroxychloroquine is used to prevent or treat malaria caused by mosquito bites. The United States Center for Disease Control provides updated guidelines and travel recommendations for the prevention and treatment of malaria in different parts of the world. Discuss the most recent information with your doctor before traveling to areas where malaria occurs.This medication is also used to treat certain auto-immune diseases (lupus, rheumatoid arthritis). It belongs to a class of medications known as disease-modifying antirheumatic drugs (DMARDs). It can reduce skin problems in lupus and prevent swelling/pain in arthritis.Hydroxychloroquine is not recommended for coronavirus infection, also known as COVID-19, unless you are enrolled in a study. Talk to your doctor about the risks and benefits.
HOW TO USE: Take this medication by mouth exactly as directed by your doctor. To help prevent stomach upset, take it with food or milk. Swallow the tablets whole since breaking or crushing them may leave a bitter taste. The dosage and length of treatment are based on your medical condition and response to treatment. Children's dose is also based on weight.To prevent malaria, take this medication by mouth as directed by your doctor, usually once a week on the same day each week. Mark a calendar to help you remember. This drug is usually started 1 to 2 weeks before entering the malarious area. Continue to take it weekly while in the area and for 4 to 8 weeks after leaving the area, or as directed by your doctor. To treat malaria, follow your doctor's instructions.For lupus or rheumatoid arthritis, take this medication by mouth as directed by your doctor, usually once or twice daily. Your doctor may gradually increase your dose. Once you have been taking the medication for a while and your condition has improved, your doctor may instruct you to lower your dose until you find the dose that works best with the fewest side effects.If you are also taking a certain drug for diarrhea (kaolin) or taking antacids (such as magnesium/aluminum hydroxide), take hydroxychloroquine at least 4 hours before or after these products. These products may bind with hydroxychloroquine, preventing your body from fully absorbing it.Use this medication regularly in order to get the most benefit from it. If you are taking it on a daily schedule, take it at the same time(s) each day. Take this medication exactly as prescribed. Do not stop taking it without talking with your doctor, especially if you are taking it for malaria. It is important to continue taking this for the length of time prescribed. Stopping prevention or treatment too soon may lead to infection or a return of the infection.Tell your doctor if your condition lasts or gets worse. It may take several weeks or months to see improvement if you are taking this for lupus or arthritis. Hydroxychloroquine may not prevent malaria in all cases. If you experience fever or other symptoms of illness, get medical help right away (especially while in the malarious area and for 2 months after returning from the area). You may need a different medication. Avoid exposure to mosquitoes. (See also Notes section.)
SIDE EFFECTS: Nausea, vomiting, loss of appetite, diarrhea, dizziness, or headache may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: slow heartbeat, symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain), mental/mood changes (such as anxiety, depression, rare thoughts of suicide, hallucinations), hearing changes (such as ringing in the ears, hearing loss), easy bruising/bleeding, signs of liver disease (such as severe stomach/abdominal pain, yellowing eyes/skin, dark urine), signs of kidney problems (such as change in the amount of urine), muscle weakness, unwanted/uncontrolled movements (including tongue/face twitching), hair loss, hair/skin color changes.This medication may cause low blood sugar (hypoglycemia). Tell your doctor right away if you develop symptoms of low blood sugar, such as sudden sweating, shaking, hunger, blurred vision, dizziness, or tingling hands/feet. If you have diabetes, be sure to check your blood sugars regularly. Your doctor may need to adjust your diabetes medication.Get medical help right away if you have any very serious side effects, including: severe dizziness, fainting, fast/irregular heartbeat, seizures.This medication may cause serious eye/vision problems. The risk for these side effects is increased with long-term use of this medication and with taking this medication in high doses. Get medical help right away if you have any symptoms of serious eye problems, including: sensitivity to light, vision changes (such as light flashes/streaks, blurred vision, difficulty reading, missing areas of vision).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking hydroxychloroquine, tell your doctor or pharmacist if you are allergic to it; or to chloroquine; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain enzyme problem (glucose-6-phosphate dehydrogenase deficiency-G6PD), vision/eye problems, hearing problems, kidney disease, liver disease, regular alcohol use/abuse, skin problems (such as psoriasis), a certain blood disorder (porphyria), seizures.If you have diabetes, this product may affect your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of low blood sugar (see Side Effects section). Your doctor may need to adjust your diabetes medication, exercise program, or diet.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis). Alcohol can also increase your risk of liver problems while you are taking this drug.This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Hydroxychloroquine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using hydroxychloroquine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using hydroxychloroquine safely.Older adults may be more sensitive to the side effects of this drug, especially QT prolongation (see above).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: penicillamine, remdesivir.Many drugs besides hydroxychloroquine may affect the heart rhythm (QT prolongation). Some examples are amiodarone, azithromycin, disopyramide, dronedarone, pimozide, quinidine, among others.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: fast/irregular heartbeat, fainting, slow/shallow breathing, seizures.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as eye exams, reflex tests, liver/kidney function, EKG, complete blood counts) should be done if you are taking hydroxychloroquine for a long time. Keep all medical and lab appointments. Consult your doctor for more details.When traveling in an area at risk for malaria, use protective clothing, insect repellent, and bed nets. Remain indoors or in well-screened areas when possible. If you are taking this medication to prevent or treat malaria, use it for your current travel or condition only. Do not use it later to prevent or treat another infection unless your doctor tells you to.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from moisture and light. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised May 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
