Hydroxychloroquine

Dosing

At 0h: Hydroxychloroquine sulfate 800 mg PO 1 dose

At 6, 24, 48h: Hydroxychloroquine sulfate 400 mg PO 1 dose

Hydroxychloroquine sulfate 400 mg PO q1w

Hydroxychloroquine sulfate 200 mg = Hydroxychloroquine base 155 mg

No renal dose adjustment

At 0h: Hydroxychloroquine base 10 mg/kg PO 1 dose (max 620 mg/dose)

At 6, 24, 48h: Hydroxychloroquine base 5 mg/kg PO 1 dose (max 310 mg/dose)

Hydroxychloroquine base 5 mg/kg PO q1w (310 mg/dose)

Hydroxychloroquine base 155 mg = Hydroxychloroquine sulfate 200 mg

No renal dose adjustment

Hepatic impairmentUse with caution

General Information

Prevention or treatment of malaria.

Treat symptoms of lupus erythematosus and rheumatoid arthritis.

Important note: The FDA revoked the Emergency Use Authorization for hydroxychloroquine in hospitalized patients for COVID-19 on June 15, 2020. The FDA determined that hydroxychloroquine is unlikely to be effective in treating COVID-19.

Malaria: termination of acute malarial attack or absence of or reduced malarial parasite count on blood smear may indicate efficacy.

Systemic lupus erythematosus/rheumatoid arthritis: improvement in C-reactive protein levels and erythrocyte sedimentation rate may indicate efficacy.

Monitor renal and hepatic functions.

Monitor ECG, electrolytes, renal function, and hepatic function at baseline and during therapy.

Perform ophthalmologic examination in all patients beginning long-term therapy within the first year; repeat screening annually.

Common

  • Nausea

Serious

  • Prolonged QT interval

  • Torsades de pointes

  • Ventricular tachycardia

  • Hypoglycemia

  • Agranulocytosis

  • Anemia

  • Hemolysis

  • Pancytopenia

  • Thrombocytopenia

  • Extrapyramidal disease

  • Retinal disorder

  • Disorder of muscle

  • Hearing loss

  • Angioedema

Contraindications:

  • QT prolonging agents

  • Aurothioglucose

Multiple drug-drug interactions:

  • QT prolonging drugs/ agents

  • Antidiabetic agents

  • Class IA and III antiarrhythmics

  • Antimalarials

Antimicrobial class: Aminoquinoline

Average serum half life: 40-50 days (chronic use)

Precautions:

  • Use caution in patients with risk factors such as history of QT prolongation, cardiac disease, and concomitant use of medications known to prolong the QT interval; monitoring recommended.

  • Use caution in patients with renal disease; dose adjustment may be necessary.

  • Use caution in patients with hepatitis, hepatic disease, alcoholism, or concomitant use of known hepatotoxic drugs; dose adjustment may be necessary.

  • Use caution with patients with G6PD deficiency.

  • Monitor for irreversible retinal damage even after discontinuation of therapy; discontinue if suspected.

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