200 mg hydroxychloroquine sulfate = 155 mg of hydroxychloroquine base
PO (Adults): Prophylaxis– 400 mg sulfate (310 mg base) once weekly; start 2 wk prior to entering malarious area; continue for 4 wk after leaving area. Treatment– 800 mg sulfate (620 mg base), then 400 mg sulfate (310 mg base) at 6 hr, 24 hr, and 48 hr after initial dose.
PO (Children ≥31 kg): Prophylaxis– 6.5 mg/kg sulfate (5 mg/kg base) (not to exceed 400 mg sulfate [310 mg base]) once weekly; start 2 wk prior to entering malarious area; continue for 4 wk after leaving area. Treatment– 13 mg/kg sulfate (10 mg/kg base) (not to exceed 800 mg sulfate [620 mg base]) initially, then 6.5 mg/kg sulfate (5 mg/kg base) (not to exceed 400 mg sulfate [310 mg base]) at 6 hr, 24 hr, and 48 hr after initial dose.
PO (Adults): 400–600 mg sulfate (310–465 mg base) per day in 1–2 divided doses; once adequate response obtained, may ↓ dose to maintenance dose of 200–400 mg sulfate (155–310 mg base) per day in 1–2 divided doses.
PO (Adults): 200–400 mg sulfate (155–310 mg base) per day in 1–2 divided doses.
Availability (generic available)
Tablets: 200 mg sulfate (155 mg base)
Assess deep tendon reflexes periodically to determine muscle weakness. Therapy may be discontinued should this occur.
Obtain baseline occular exam within first yr of therapy. Patients on prolonged high-dose therapy should have eye exams prior to and every 3–6 mo during therapy to detect retinal damage. Monitor patients without risk factors every 5 yrs. Retinal changes may progress even after therapy is completed.
Monitor ECG for cardiomyopathy and QT prolongation periodically during therapy.
Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, and/or facial swelling, associated with involvement of other organ systems (hepatitis, nephritis, hematologic abnormalities, myocarditis, myositis) during therapy. May resemble an acute viral infection. Eosinophilia is often present. Discontinue therapy if signs occur.
Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia.
Assess for suicidal tendencies, depression, or changes in behavior periodically during therapy.
Malaria or Lupus Erythematosus: Assess patient for improvement in signs and symptoms of condition daily throughout course of therapy.
Rheumatoid Arthritis: Assess patient monthly for pain, swelling, and range of motion.
Lab Test Considerations:
Monitor CBC and platelet count periodically throughout therapy. May cause decreased RBC, WBC, and platelet counts. If severe decreases occur that are not related to the disease process, hydroxychloroquine should be discontinued.
Monitor liver function tests periodically during therapy.
Do not confuse hydroxychloroquine with hydroxyurea.
PO Administer with milk or meals to minimize GI distress.
Tablets may be crushed and placed inside empty capsules for patients with difficulty swallowing. Contents of capsules may also be mixed with a teaspoonful of jam, jelly, or Jell-O prior to administration.
Malaria Prophylaxis: Hydroxychloroquine therapy should be started 2 wk prior to potential exposure and continued for 4–6 wk after leaving the malarious area.
Instruct patient to take medication exactly as directed and continue full course of therapy even if feeling better. Missed doses should be taken as soon as remembered unless it is almost time for next dose. Do not double doses.
Advise patients to avoid use of alcohol while taking hydroxychloroquine.
Caution patient to keep hydroxychloroquine out of reach of children; fatalities have occurred with ingestion of 3 or 4 tablets.
Explain need for periodic ophthalmic exams for patients on prolonged high-dose therapy. Advise patient that the risk of ocular damage may be decreased by the use of dark glasses in bright light. Protective clothing and sunscreen should also be used to reduce risk of dermatoses.
Advise patient to notify health care professional promptly if sore throat, fever, unusual bleeding or bruising, blurred vision, visual changes, ringing in the ears, difficulty hearing, or muscle weakness occurs.
Advise female patient to notify health care professional if pregnancy is planned or suspected, or if breast feeding.
Malaria Prophylaxis: Review methods of minimizing exposure to mosquitoes with patients receiving hydroxychloroquine prophylactically (use repellent, wear long-sleeved shirt and long trousers, use screen or netting).
Advise patient to notify health care professional if fever develops while traveling or within 2 mo of leaving an endemic area.
Rheumatoid Arthritis: Instruct patient to contact health care professional if no improvement is noticed within a few days. Treatment for rheumatoid arthritis may require up to 6 mo for full benefit.
Prevention or resolution of malaria.
Improvement in signs and symptoms of rheumatoid arthritis.
Improvement in symptoms of lupus erythematosus.
hydroxychloroquine is a sample topic from the Davis's Drug Guide.
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