• Treatment of uncomplicated malaria in geographic areas where chloroquine resistance is not reported.
• Prophylaxis of malaria in geographic areas where chloroquine resistance is not reported.
• Acute and chronic rheumatoid arthritis.
• Chronic discoid lupus erythematosus and systemic lupus erythematosus.

Contraindicated in:

• Hypersensitivity to hydroxychloroquine or chloroquine
• Previous visual damage from hydroxychloroquine or chloroquine.

Use Cautiously in:

• Concurrent use of hepatotoxic drugs
• Hepatic impairment or alcoholism
• Use of high doses (>5 mg/kg/day), duration of use >5 yr, renal impairment, concurrent use of tamoxifen or macular disease (↑ risk of retinopathy)
• Glucose-6–phosphate dehydrogenase deficiency
• Psoriasis
• Porphyria
• Bone marrow depression
• Obesity (determine dose by ideal body weight)
• Pedi: Safety and effectiveness for treatment of rheumatoid arthritis, chronic discoid lupus erythematosus, or systemic lupus erythematosus not established in children
• Geri: ↓ renal function may ↑ risk of adverse reactions in older adults.

CV: QT interval prolongation, heart block, HF, TORSADES DE POINTES.

Derm: acute generalized exanthematous pustulosis, alopecia, DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), ERYTHEMA MULTIFORME, hair color changes, hyperpigmentation, photosensitivity, pruritus, rash, STEVENS-JOHNSON SYNDROME (SJS), TOXIC EPIDERMAL NECROLYSIS, urticaria.

EENT: corneal deposits, nystagmus, retinopathy, tinnitus, vertigo, visual disturbances.

Endo: hypoglycemia.

GI: ↑ liver enzymes, abdominal pain, anorexia, diarrhea, HEPATOTOXICITY, nausea, vomiting.

GU: proteinuria.

Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, leukopenia, thrombocytopenia.

Metab: ↓ weight.

Neuro: aggressiveness, anxiety, ataxia, dizziness, dyskinesia, dystonia, fatigue, headache, irritability, neuromyopathy, nightmares, peripheral neuritis, personality changes, psychoses, SEIZURES, SUICIDAL THOUGHTS/BEHAVIORS, tremor.

Resp: bronchospasm, PULMONARY HYPERTENSION.
Misc: ANGIOEDEMA.

Drug-Drug:

• Concurrent use of other QT interval-prolonging drugs may ↑ risk of torsades de pointes.
• May ↑ the risk of hepatotoxicity when administered with hepatotoxic drugs.
• May ↑ risk of hypoglycemia when used with antidiabetic agents.
• Use with mefloquine may ↑ risk of seizures.
• Antacids may bind to and ↓ the absorption of hydroxychloroquine; separate administration by ≥4 hr.
• Cimetidine may ↑ levels; avoid concurrent use.
• Urinary acidifiers may ↑ renal excretion.
• May ↑ levels of digoxin or cyclosporine.

(Generic available)

• Tablets: 100 mg; 200 mg; 300 mg; 400 mg;

Malaria

• PO (Adults): Prophylaxis: 400 mg once weekly; start 2 wk prior to entering malarious area; continue for 4 wk after leaving area. Treatment: 800 mg initially, then 400 mg at 6 hr, 24 hr, and 48 hr after initial dose.
• PO (Children ≥31 kg): Prophylaxis: 6.5 mg/kg (not to exceed 400 mg) once weekly; start 2 wk prior to entering malarious area; continue for 4 wk after leaving area. Treatment: 13 mg/kg (not to exceed 800 mg) initially, then 6.5 mg/kg (not to exceed 400 mg) at 6 hr, 24 hr, and 48 hr after initial dose.

Rheumatoid Arthritis

• PO (Adults): 400–600 mg per day in 1–2 divided doses; once adequate response obtained, may ↓ dose to maintenance dose of 200–400 mg per day in 1–2 divided doses.

Lupus Erythematosus

• PO (Adults): 200–400 mg per day in 1–2 divided doses.

Plaquenil

• Inhibits protein synthesis in susceptible organisms by inhibiting DNA and RNA polymerase.

• Death of plasmodia responsible for causing malaria.
• Also has anti-inflammatory properties.

Spectrum:

• Active against chloroquine-sensitive strains of: Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale, and Plasmodium vivax.

Therapeutic Classification: antimalarials, antirheumatics (DMARDs)

Absorption: Highly variable (31–100%) following oral administration.

Distribution: Widely distributed; high concentrations in RBCs; crosses the placenta; excreted into breast milk.

Metabolism/Excretion: Partially metabolized by the liver to active metabolites; partially excreted unchanged by the kidneys.

Half-life: 40 days.

(plasma concentrations)

†Onset of antirheumatic action may take 6 wk.

• Instruct patient to take medication as directed and continue full course of therapy even if feeling better. Take missed doses as soon as remembered unless it is almost time for next dose. Do not double doses.
• Advise patients to avoid use of alcohol while taking hydroxychloroquine.
• Caution patient to keep hydroxychloroquine out of reach of children; fatalities have occurred with ingestion of 3 or 4 tablets.
• Explain need for periodic ophthalmic exams for patients on prolonged high-dose therapy. Advise patient that the risk of ocular damage may be decreased by the use of dark glasses in bright light. Protective clothing and sunscreen should also be used to reduce risk of dermatoses.
• Advise patient to notify health care professional promptly if sore throat, fever, unusual bleeding or bruising, blurred vision, visual changes, ringing in the ears, difficulty hearing, or muscle weakness occurs.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breastfeeding. Inform patient of pregnancy exposure registry that monitors pregnancy outcomes in women exposed to hydroxychloroquine during pregnancy. Encourage patients to register by calling 1-877-311-8972.
• Malaria Prophylaxis: Review methods of minimizing exposure to mosquitoes with patients receiving hydroxychloroquine prophylactically (use repellent, wear long-sleeved shirt and long trousers, use screen or netting).
  • Advise patient to notify health care professional if fever develops while traveling or within 2 mo of leaving an endemic area.
• Rheumatoid Arthritis: Instruct patient to contact health care professional if no improvement is noticed within a few days. Treatment for rheumatoid arthritis may require up to 6 mo for full benefit.

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