Hydroxychloroquine

• Used for rheumatoid arthritis, lupus erythematosus and lichen planus
• Also used to treat or prevent malaria
• Take tablet with food

Hydroxychloroquine works by reducing inflammation and kills a wide range of bacteria and parasites. It is used in adults and children (aged six and above weighing 31 kg or more) for the treatment of:

• Rheumatoid arthritis and childhood rheumatism (juvenile idiopathic arthritis).
• Discoid and systemic lupus erythematosus.
• Acute attacks of malaria and to prevent malaria.

In adults, this medicine is also used for phytophotodermatitis (a skin condition caused by exposure sunlight).

The tablets should be taken with food to prevent side effects such as nausea. If you feel the effect of your medicine is too weak or too strong, do not change the dose yourself, but consult your doctor or pharmacist.

Dosage

Dosage varies per person and is determined by a doctor depending on the symptoms. The general recommended dose in adults is:

For rheumatoid arthritis:

• Starting dose: 400 mg per day, taken as a single dose or divided in two doses.
• Maintenance dose: 200 mg per day, later possibly 200 mg every other day.

For systemic and discoid lupus erythematosus:

• Starting dose: 400 mg (taken as a single dose or divided in two doses) to 600 mg (taken as a single dose or divided in three doses) per day.
• Maintenance dose: 200 mg to 400 mg (taken as a single dose or divided in two doses) per day.

For skin conditions due to sunlight:

The treatment is limited to those periods in which you are exposed to a lot of light.

• Dosage: 400 mg a day, taken as a single dose or divided in two doses, is usually enough.

To prevent malaria:

• Adults: 400 mg a week, taken on the same day of the week. In the prevention of malaria, you must receive treatment for one week before arrival in the malaria area and continue it for four weeks after departure from that area.

To treat malaria:

• The dose in case of an acute attack of malaria depends on the nature of the infection. The total dose is a maximum of 2 grams and is administered over a maximum of three days.

For children (juvenile arthritis, lupus erythematosus, malaria)

Your doctor will determine the dose based on body weight. Hydroxychloroquine is not suitable for children under the age of six with a body weight of less than 31 kg.

Alcohol/driving

You may get eye problems or feel dizzy after taking this medicine. If this happens, do not drive or use any tools or machines and tell your doctor straight away.

If you use too much/forget to use/stop using Hydroxychloroquine

If you take more tablets than you were told to, consult your doctor or pharmacist.

If you forget to take a dose of Hydroxychloroquine, you may take it as soon as you remember, unless it is almost time for your next scheduled dose. Do not take a double dose to make up for the forgotten one.

Do not stop using Hydroxychloroquine without talking to your doctor.

Do not take this medicine if:

• You are allergic to any of the ingredients in this medicine (see section ‘What Hydroxychloroquine contains’) or other similar medicines such as quinolones and quinine (other medicines used for malaria).
• You have certain eye problems (maculopathy of the eye or retinitis pigmentosa).
• You are suffering from a certain form of muscle weakness (myasthenia gravis).

When should this medicine be used with caution?

Some people being treated with Hydroxychloroquine can experience mental health problems such as irrational thoughts, anxiety, hallucinations, feeling confused or feeling depressed, including thoughts of self-harm or suicide, even those who have never had similar problems before. If you or others around you notice any of these side effects seek medical advice straight away.

Talk to your doctor or pharmacist before taking this medicine if:

• You have liver or kidney problems.
• You have serious stomach or gut problems.
• You are taking a medicine called tamoxifen, used to treat breast cancer.
• You have any problems with your blood.
• You have heart problems (signs include breathlessness and chest pain) which may require monitoring.
• You have any problems with your nervous system or brain.
• You have, or have had, psoriasis.
• You have had a bad reaction to quinine in the past.
• You have a genetic condition known as glucose6-dehydrogenase deficiency or a rare illness called porphyria.
• You are suffering from hearing loss.
• You were born with or have family history of prolonged QT interval, if you have acquired QT prolongation, if you have heart disorders or have a history of heart attack (myocardial infarction), if you have salt imbalance in the blood (especially low level of potassium or magnesium), see section ‘Other medicines and Hydroxychloroquine.
• If you experience palpitations or irregular heartbeat during the period of treatment, you should inform your doctor immediately.

Hydroxychloroquine can cause lowering of the blood glucose level. Please ask your doctor to inform you of signs and symptoms of low blood glucose levels. A check of the blood glucose level may be necessary.

Before you start taking this medicine your doctor will examine your eyes to determine if there are any abnormalities.

If you are using this medicine for a long period, your muscles and tendons will need to be periodically checked. Contact your doctor if you start suffering from weak muscles or tendons.

Pregnancy and breastfeeding

Do not use Hydroxychloroquine during pregnancy in high daily doses unless your doctor says this is necessary. This medicine can be used during pregnancy to prevent malaria, as only low doses are required.

Your doctor will decide whether you can use this medicine during breastfeeding. When you take this medicine once per week, such as to prevent malaria, you do not have to stop breastfeeding.

Other medicines and Hydroxychloroquine

Tell your doctor if you are taking, have recently taken or might take any other medicines. Hydroxychloroquine interacts with the following:

• Certain medicines to treat depression (monoamine oxidase (MAO) inhibitors) should not be combined with Hydroxychloroquine.
• Digoxin.
• Rabies vaccine.
• Certain antimalarial medicines (e.g., mefloquine).
• Certain medicines for diabetes (e.g., insulin or metformin).
• Medicines known to affect the rhythm of your heart.

See the package leaflet for more information.

Like all medicines, Hydroxychloroquine can cause side effects, although some people may not experience any.

If you get any of the following serious side effects, stop taking this medicine and tell your doctor immediately, or contact the casualty department at your nearest hospital:

• Severe skin reactions.
• Eye problems or visual disturbances.
• Fits/seizures.
• Difficulty breathing, coughing, high blood pressure, swelling, increased heart rate these may be signs of weakening of the heart muscle (cardiomyopathy or heart failure).
• Feeling depressed or having thoughts of selfharm or suicide, hallucinations or other psychological symptoms.

For more information of the symptoms of these serious side effects, please see the package leaflet.

Other side effects associated with Hydroxychloroquine:

Common (may affect up to 1 in 10 people):

• Loss of appetite.

Uncommon (may affect up to 1 in 100 people):

• Nausea, diarrhoea, abdominal pain. These symptoms usually disappear after lowering the dose or stopping treatment.
• Skin rash.

Rare (may affect up to 1 in 1,000 people):

• Vomiting (this usually disappears after lowering the dose or stopping treatment).
• Decrease in bone marrow activity (myelosuppression).

For a complete list of rare side effects, see the package leaflet. If you experience side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet.

One Hydroxychloroquine tablet contains 200 mg of the active ingredient hydroxychloroquine sulphate.

Read the package leaflet before use. The official package leaflet of Hydroxychloroquine is available for download here.