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Apo-Hydroxychloroquine (CA), Gen-Hydroxychloroquine (CA), Plaquenil
Pharmacologic class: 4-aminoquinolone
Therapeutic class: Antimalarial, antirheumatic, anti-inflammatory (disease-modifying)
Pregnancy risk category C
FDA Box Warning
Unknown. Thought to interfere with inhibition of protein synthesis and DNA replication, leading to parasitic death.
Tablets: 200 mg (155 mg base); 200 mg hydroxychloroquine sulfate is equivalent to 155 mg of hydroxychloroquine base
⊘Indications and dosages
➣ Malaria prophylaxis (dosages expressed as mg of base)
Adults: 310 mg P.O. q week, starting 1 to 2 weeks before entering endemic area and continuing for 4 weeks after leaving area
Children: 5 mg/kg P.O. q week, starting 1 to 2 weeks before entering endemic area and continuing for 4 weeks after leaving area
➣ Acute malarial attack (dosages expressed as mg of base)
Adults: Initially, 620 mg P.O., then 310 mg 6 hours, 24 hours, and 48 hours later
Children: Initially, 10 mg/kg P.O., then 5 mg/kg 6 hours, 24 hours, and 48 hours later
➣ Rheumatoid arthritis
Adults: 400 to 600 mg/day P.O. for 4 to 12 weeks, then reduced by 50%
➣ Systemic lupus erythematosus
Adults: 400 mg P.O. once or twice daily for several months, then reduced to 200 to 400 mg daily, depending on response
• Hypersensitivity to drug or chloroquine
• Retinal or visual field changes
• Long-term therapy in children
Use cautiously in:
• hepatic or renal impairment, G6PD deficiency, psoriasis, bone marrow depression, alcoholism
• obese patients
• pregnant or breastfeeding patients
• Give with food or milk.
• For malaria prophylaxis, schedule doses on same day each week.
CNS: anxiety, apathy, confusion, fatigue, headache, psychoses, mood swings, irritability, neuromyopathy, peripheral neuritis, seizures
CV: ECG changes, hypotension
EENT: visual disturbances, retinopathy, keratopathy, ototoxicity, tinnitus
GI: nausea, vomiting, diarrhea, abdominal cramps, anorexia
Hematologic: leukopenia, agranulocytosis, aplastic anemia, thrombocytopenia
Hepatic: jaundice, hepatotoxicity
Musculoskeletal: muscle weakness
Skin: dermatoses, rash, pruritus, pigmentation changes, pleomorphic skin eruption, worsened psoriasis, alopecia, bleaching of hair
Other: weight loss
Drug-diagnostic tests.Granulocytes, hemoglobin, platelets: decreased values
Drug-behaviors.Sun exposure: exacerbation of drug-induced dermatoses
☞ Monitor for signs and symptoms of overdose, such as nausea, vomiting, drowsiness, visual disturbances, cardiovascular collapse, and seizures.
• Watch for adverse reactions.
• Advise patient to take with food or milk.
☞ Instruct patient to immediately report such adverse reactions as vision changes, nausea, vomiting, drowsiness, mental changes, mood swings, headache, ringing in ears, muscle weakness, rash, bleeding, bruising, and yellowing of skin and eyes.
• In long-term therapy, advise patient to have regular eye exams.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.