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Hydroxy-chloroquine information from DrugsUpdate  

See Available Brands of Hydroxy-chloroquine in India

P - Caution when used during pregnancy
L - Caution when used during lactation

Hydroxychloroquine is an antimalarial drug, sold under the trade name Plaquenil, also used to reduce inflammation in the treatment of Rheumatoid arthritis (see Disease-modifying antirheumatic drugs) and lupus.

Pharmacodynamics

Pharmacokinetics

Hydroxychloroquine is a 4-aminoquinoline antimalarial with actions similar to those of chloroquine but is mainly used in the treatment of SLE and rheumatoid arthritis. It interferes with digestive vacuole function within susceptible malarial parasites by increasing pH and interrupting with lysosomal degradation of Hb thus impeding normal cell function of sensitive parasites.

Onset
Rheumatic disease: 4-6 weeks may be needed for response to be observed.

Absorption
Oral absorption is rapid and complete.

Distribution
Protein binding: 55%.

Metabolism
Via liver.

Excretion
Via urine as metabolites and unchanged drug. Half-life elimination: 32-50 days.

Hydroxy-chloroquine Indications / Hydroxy-chloroquine Uses

Information Not Available

Hydroxy-chloroquine Adverse Reactions / Hydroxy-chloroquine Side Effects

Retinopathy, hair loss, photosensitivity, tinnitus, myopathy (long-term therapy). Psychosis, seizures, leucopenia and rarely aplastic anaemia, hepatitis, GI upsets, dizziness, hypokalaemia, headache, pruritus, urticaria, difficulty in visual accommodation. Loss of hair, bleaching of hair pigment, bluish-black pigmentation of the mucous membranes and skin, photosensitivity, tinnitus, reduced hearing, nerve deafness, neuromyopathy, and myopathy, including cardiomyopathy.

Precautions

Antimalarial compounds should be used with caution in patients with hepatic disease or alcoholism or in conjunction with known hepatotoxic drugs.

Periodic blood cell counts should be made if patients are given prolonged therapy. If any severe blood disorder appears which is not attributable to the disease under treatment, discontinuation of the drug should be considered. The drug should be administered with caution in patients having G-6-PD (glucose-6-phosphate dehydrogenase) deficiency.


Overdosage
Headache, visual disturbances, cardiovascular collapse, convulsions, hypokalaemia, and rhythm and conduction disorders, followed by sudden and early respiratory and cardiac arrest. Treatment should be prompt and symptomatic as symptoms appear quickly.. Empty stomach comtents either by emesis or by gastric lavage. If within 30 min of overdose, introduce activated charcoal in a dose at least five times of the overdose into the stomach by tube following lavage to inhibit further absorption. Admin of parenteral diazepam may be beneficial in reversing chloroquine cardiotoxicity. Respiratory support and shock management should be instituted as needed.

Special Precautions

Impaired liver or renal function, severe GI disorders, porphyria, psoriasis, neurological disorders especially a history of epilepsy, myasthenia gravis, G6PD deficiency, pregnancy, lactation. Monitor CBC in patients receiving prolonged therapy. Perform baseline and periodic 6-mth eye exams, test periodically for muscle weakness.

Other Drug Interactions

Cimetidine may increase serum levels of hydroxychloroquine. Its absorption may be decreased by kaolin or Mg trisilicate. Avoid digoxin and alcohol. Increased risk of ventricular arrhythmias when used with halofantrine. Concurrent use with mefloquine may increase the risk of convulsions.

Other Interactions

Information Not Available

Dosage

Oral
Rheumatoid arthritis
Adult: Initially, 400 mg daily in divided doses. Maintenance: 200-400 mg/day. Max: 6.5 mg/kg/day or 400 mg/day whichever is lower.
Child: Up to 6.5 mg/kg/day or 400 mg/day whichever is lower. Lowest effective dose should be used.

Renal impairment: Estimation of plasma hydroxychloroquine levels to be undertaken in patients with severely compromised function and dosage adjusted accordingly.
Hepatic impairment: Estimation of plasma hydroxychloroquine levels to be undertaken in patients with severely compromised function and dosage adjusted accordingly.

Oral
Systemic lupus erythematosus
Adult: Initially, 400 mg daily in divided doses. Maintenance: 200-400 mg/day. Max: 6.5 mg/kg/day or 400 mg/day whichever is lower.
Child: Up to 6.5 mg/kg/day or 400 mg/day whichever is lower. Lowest effective dose should be used.

Renal impairment: Estimation of plasma hydroxychloroquine levels to be undertaken in patients with severely compromised function and dosage adjusted accordingly.
Hepatic impairment: Estimation of plasma hydroxychloroquine levels to be undertaken in patients with severely compromised function and dosage adjusted accordingly.

Oral
Prophylaxis of malaria
Adult: 400 mg every 7 days. Begin 2 weeks before exposure, continue for 4-6 weeks after leaving the endemic area.
Child: 6.5 mg/kg once wkly. Max: 400 mg/dose.

Oral
Acute malaria
Adult: Initially, 800 mg followed by 400 mg 6-8 hr later, then a further 400 mg on each of the succeeding 2 days.
Child: 13 mg/kg; followed by 6.5 mg/kg 6 hr later and repeat dose on the 2nd and 3rd days.

Food(before/after)

Should be taken with food

List of Contraindications

Hydroxy-chloroquine and Pregnancy

Caution when used during pregnancy

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Hydroxy-chloroquine and Lactation

Caution when used during lactation

Hydroxy-chloroquine and Children

Information Not Available

Hydroxy-chloroquine and Geriatic

Information Not Available

Hydroxy-chloroquine and Other Contraindications

Retinal or visual field changes, known hypersensitivity. Long-term use in children.

Storage

Information Not Available

Lab interference

Information Not Available

Hydroxy-chloroquine brands in India:

Arthoquin Hcqs Hqtor Hydrocad Hydroquin Mcqs Oxcq Oxy-Q Rhq Winflam Zy-Q

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