Antimicrobials
Hydroxychloroquine (Plaquenil)

Hydroxychloroquine (Plaquenil)

Dosing

400 mg PO bid x 1 day, then 200 mg PO bid for 4 days

Infants > 6 months and childrenInfants < 6 months and neonates6.5 mg/kg PO BID (up to max 400 mg BID) on day 1, then 3.25 mg/kg PO BID (up to max 200mg BID) x 4 days6 mg/kg PO BID x 1 day, then:

  • < 5 kg: 3 mg/kg PO BID x 4 days

  • 5 to 15 kg: 5 mg/kg PO BID x 4 days

No published neonatal dosing recommendations available; dosing presented comes from PK modelling (Cohen-Wolkowiez et al 2020).

General Information

Potent inhibitor of SARS-CoV-2 in vitro. 5-day therapy results in sustained levels in lung tissue. There is a theoretic rationale to use hydroxychloroquine to prevent “cytokine storm”, however its role in therapy is not established. There may therefore be more of a role in earlier infection.

Not required for short course

Dizziness, headache, anorexia, nausea, vomiting, bloating, glucose abnormalities Most serious toxicities associated with long term use

Serious: Retinopathy, LFT abnormalities, QT prolongation, hemolysis in G6PD deficient patients

  • Prodrug of chloroquine; chloroquine is not currently available in Canada

  • Limited supply of tablets available

  • Consult Infectious Diseases in person or by phone for consideration of any directed COVID-19 therapy

In vitro data show antiviral activity; influenza prevention trial show negative result. Potential toxicity and immunomodulation. Unpublished clinical data on hydroxychloroquine (+ macrolide) showed viral suppression.

Reference: Yao X, et al. Clin Infect Dis. 2020 Mar 9, ciaa237. Paton NI, et al. Lancet Infect Dis. 2011;11(9):677-83. Cortegiani A, et al. J Crit Care 202