Hydroxychloroquine: use, side effects, work & composition

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Hydroxychloroquine

Hydroxychloroquine is a quinoline medicine used to treat or prevent malaria, a disease caused by parasites that enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia. This medicine is not effective against all strains of malaria.

Hydroxychloroquine is not effective against all strains of malaria, or against malaria in areas where the infection has been resistant to a similar drug called chloroquine.

Hydroxychloroquine is also used to treat symptoms of rheumatoid arthritis and discoid or systemic lupus erythematosus.

Hydroxychloroquine has not been approved to treat coronavirus or COVID-19. However, the US Food and Drug Administration (FDA) has authorized emergency use of hydroxychloroquine in adults and adolescents weighing at least 110 pounds (50 kilograms) who are hospitalized with COVID-19.

Hydroxychloroquine is being used to try and stop coronavirus from spreading inside your body. It is not yet known if hydroxychloroquine is a safe and effective treatment for COVID-19, and this use is still experimental.

How to use Hydroxychloroquine SULFATE

Take this medication by mouth, usually with food to prevent stomach upset, exactly as directed by your doctor. The dosage and length of treatment are based on your medical condition and response to treatment. In children, the dosage 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.

Important Information

Hydroxychloroquine has not been approved to treat coronavirus or COVID-19. However, the FDA has authorized emergency use in adults and adolescents hospitalized with COVID-19. It is not yet known if hydroxychloroquine is an effective treatment for COVID-19. This use is still experimental.

Taking hydroxychloroquine long-term or at high doses may cause irreversible damage to the retina of your eye. Stop taking hydroxychloroquine and call your doctor at once if you have blurred vision, trouble focusing, distorted vision, blind spots, trouble reading, changes in your color vision, increased sensitivity to light.

Before using hydroxychloroquine, tell your doctor if you are allergic to any drugs, or if you have psoriasis, porphyria, liver disease, alcoholism, or glucose-6-phosphate dehydrogenase (G-6-PD) deficiency.

Call a poison control center at once and then seek emergency medical attention if you think you have used too much of this medicine. An overdose of hydroxychloroquine can be fatal, especially in children.

Take hydroxychloroquine for the full prescribed length of time for malaria. Your symptoms may improve before the infection is completely cleared.

When treating lupus or arthritis, tell your doctor if your symptoms do not improve after 6 months of treatment.

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.

Before taking this medicine

You should not use hydroxychloroquine if you are allergic to hydroxychloroquine or chloroquine.

High doses or long-term use of hydroxychloroquine may cause irreversible damage to your retina (the membrane layer inside your eye that helps produce vision). This could progress to permanent vision problems. The risk of retinal damage is higher in people with pre-existing eye problems, kidney disease, or people who also take tamoxifen.

To make sure hydroxychloroquine is safe for you, tell your doctor if you have ever had:

  • vision changes or damage to your retina caused by an anti-malaria medication;
  • heart disease, heart rhythm disorder (such as long QT syndrome);
  • diabetes;
  • a stomach disorder;
  • an allergy to quinine;
  • liver or kidney disease;
  • psoriasis;
  • alcoholism;
  • porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system); or
  • a genetic enzyme deficiency called glucose-6-phosphate dehydrogenase (G6PD) deficiency.

Tell your doctor if you are pregnant or plan to become pregnant. Malaria is more likely to cause serious illness or death in a pregnant woman. Having malaria during pregnancy may also increase the risk of miscarriage, stillbirth, premature delivery, and low birth weight.

It is not known whether hydroxychloroquine will harm an unborn baby. If you are pregnant, ask your doctor about the risks of traveling to areas where malaria is common.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.

Hydroxychloroquine is not approved for treating lupus or rheumatoid arthritis in anyone younger than 18 years old.

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 your doctor has prescribed this medication because he or she 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 infection (such as sore throat that doesn’t go away, fever), signs of liver disease (such as severe stomach/abdominal pain, yellowing eyes/skin, dark 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 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.

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.

How should I take hydroxychloroquine?

Take hydroxychloroquine exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

The best hydroxychloroquine dose to treat COVID-19 is not known. Follow your doctor’s dosing instructions very carefully.

To treat lupus or arthritis, hydroxychloroquine is usually taken daily.

To prevent malaria: Hydroxychloroquine is usually taken once per week on the same day each week. Start taking the medicine 2 weeks before entering an area where malaria is common. Keep taking the medicine during your stay and for at least 4 weeks after you leave the area.

To treat malaria: Hydroxychloroquine is usually given as one high dose followed by smaller doses during the next 2 days in a row.

Take hydroxychloroquine with a meal or a glass of milk unless your doctor tells you otherwise.

Use this medicine for the full prescribed length of time, even if your symptoms quickly improve.

Call your doctor as soon as possible if you have been exposed to malaria, or if you have fever or other symptoms of illness during or after a stay in an area where malaria is common.

Use protective clothing, insect repellents, and mosquito netting around your bed to further prevent mosquito bites that could cause malaria.

No medication is 100% effective in treating or preventing all types of malaria. Talk with your doctor if you have fever, vomiting, or diarrhea during your treatment.

If you use this medicine long-term, you may need frequent medical tests and vision exams.

While using hydroxychloroquine, you may need frequent blood tests and vision exams.

Store at room temperature away from moisture, heat, and light.

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.

A product that may interact with this drug is: penicillamine.

Hydroxychloroquine dosing information

Usual Adult Dose for Malaria Prophylaxis:

400 mg salt (310 mg base) orally once a week

Weight-based dosing: 6.5 mg/kg salt (5 mg/kg base) orally once a week
-Maximum dose: 400 mg salt (310 mg base)/dose

Comments:
-This drug should be administered on the same day of each week.
-The suppressive therapy should begin 2 weeks prior to exposure and should continue for 4 weeks after leaving the endemic area.

Use: For the prophylaxis of malaria in geographic areas where chloroquine resistance is not reported

US CDC Recommendations: 310 mg base (400 mg salt) orally once a week

Comments:
-An alternative to chloroquine for prophylaxis only in areas with chloroquine-sensitive malaria
-Prophylaxis should start 1 to 2 weeks before travel to malarious areas; should continue weekly (same day each week) while in malarious areas and for 4 weeks after leaving such areas
-If malaria develops while using this drug for chemoprophylaxis, it should not be used as part of the treatment regimen.
-Current guidelines should be consulted for additional information.

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 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.

What other drugs will affect hydroxychloroquine?

Hydroxychloroquine can cause a serious heart problem. Your risk may be higher if you also use certain other medicines for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.

If you take an antacid or Kaopectate (kaolin-pectin), take it 4 hours before or 4 hours after you take your hydroxychloroquine dose.

Tell your doctor about all your other medicines, especially:

  • cimetidine;
  • cyclosporine;
  • methotrexate;
  • praziquantel;
  • tamoxifen;
  • heart rhythm medicine;
  • insulin or oral diabetes medicine; or
  • seizure medication.

This list is not complete. Other drugs may interact with hydroxychloroquine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Pregnancy and breastfeeding

We suggest you discuss your medication with your doctor if you’re planning to have a baby, become pregnant or are thinking of breastfeeding.

Current guidelines state that hydroxychloroquine can be taken during pregnancy. It’s often best to continue with it to prevent a flare-up of your condition as the benefits usually outweigh any possible risks.

You can also breastfeed while you’re on hydroxychloroquine. Hardly any of the drug passes into the breast milk and there’s no evidence it has any effect on the baby.

Composition and Active Ingredients

Hydroxychloroquine Tablet is composed of the following active ingredients (salts)

  • Hydroxychloroquine – 200MG

Please note that this medicine may be available in various strengths for each active ingredient listed above.

Expired Hydroxychloroquine Tablet

  • Taking a single dose of expired Hydroxychloroquine Tablet is unlikely to produce an adverse event. However, please discuss with your primary health provider or pharmacist for proper advice or if you feel unwell or sick. Expired drugs may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drugs. If you have a chronic illness that requires taking medicine constantly such as heart condition, seizures, and life-threatening allergies, you are much safer keeping in touch with your primary health care provider so that you can have a fresh supply of unexpired medications.

F&Qs

1) Is it safe to drive or operate heavy machinery when using this product?

Ans. If you experience drowsiness, dizziness, hypotension, or a headache as side-effects when using Hydroxychloroquine Tablet medicine then it may not be safe to drive a vehicle or operate heavy machinery. One should not drive a vehicle if using the medicine makes you drowsy, dizzy or lowers your blood-pressure extensively. Pharmacists also advise patients not to drink alcohol with medicines as alcohol intensifies drowsiness side-effects. Please check for these effects on your body when using Hydroxychloroquine tablets. Always consult with your doctor for recommendations specific to your body and health conditions.

2) Can Hydroxychloroquine Tablet be used for rheumatoid arthritis and arthritis?

Ans. Yes, rheumatoid arthritis and arthritis are among the most common reported uses for Hydroxychloroquine tablets. Please do not use Hydroxychloroquine Tablets for rheumatoid arthritis and arthritis without consulting first with your doctor.

3) Is Hydroxychloroquine Tablet safe to use when pregnant?

Ans. Please consult with your doctor for case-specific recommendations

4) Should I use Hydroxychloroquine Tablet empty stomach, before food or after food?

Ans. TabletWise.com website users have most commonly reported using Hydroxychloroquine Tablet after food. However, this may not be reflective of how you should use this medicine. Please follow your doctor’s advice on how you should use this medicine.

5) Is Hydroxychloroquine Tablet safe while breastfeeding?

Ans. Please discuss the risks and benefits with your doctor.

6) Is this medicine or product addictive or habit forming?

Ans. Most medicines don’t come with the potential for addiction or abuse. Usually, the government’s categorizes medicines that can be as addictive as controlled substances. Examples include schedule H or X in India and schedule II-V in the US. Please consult the product package to make sure that the medicine does not belong to such special categorizations of medicines. Lastly, do not self-medicate and increase your body’s dependence on medicines without the advice of a doctor.

7) How long do I need to use Hydroxychloroquine Tablet before I see improvement of my conditions?

Ans. TabletWise.com website users have reported 1 week and same day as the most common time it takes before they saw improvements in their conditions. These times may not be reflective of what you may experience or how you should use this medicine. Please consult with your doctor to check how long do you need to use Hydroxychloroquine Tablet.

8) Can i stop using this product immediately or do I have to slowly ween off the use?

Ans. Some medicines need to be tapered or cannot be stopped immediately because of rebound effects. Please consult with your doctor for recommendations specific to your body, health, and other medications that you may be using.