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Hydroxychloroquine

Hydroxychloroquine is an antimalarial medicine that is used to treat and prevent infection by the malaria parasite. It also has anti-inflammatory activity. Hydroxychloroquine is suitable for use in adults and children weighing 35 kg or more.

What is hydroxychloroquine?

Hydroxychloroquine kills certain bacteria and parasites, such as the malaria parasite. It is used to treat and prevent malaria, a tropical disease that is spread by the bite of mosquitoes infected with malaria parasites. It also reduces inflammation.

Hydroxychloroquine is a type of medicine called a disease-modifying anti-rheumatic drug (DMARD), which is indicated for the treatment of certain forms of rheumatoid arthritis.

When is hydroxychloroquine used?

Hydroxychloroquine is primarily prescribed to treat:

  • Rheumatoid arthritis Commonly referred to simply as arthritis, this is a chronic inflammatory condition of the joints (usually the wrists, ankles and knees). It is characterised by symptoms such as pain, swelling and stiffness of the affected joint. Hydroxychloroquine reduces the inflammation in the joints and the associated swelling and pain, making it easier to move around and do everyday activities.
  • Juvenile idiopathic arthritis Children can also be affected by types of arthritis, sometimes at a very young age. The oligoarticular form of juvenile idiopathic arthritis can start in children from the age of two and affects four or fewer joints. If juvenile idiopathic arthritis appears at a later age (in children from the age of six), more than four joints are typically affected. Juvenile idiopathic arthritis can cause symptoms such as fatigue, eye infection and fever.
  • Malaria In malarial areas, certain mosquitoes can spread the malaria parasite to people. The parasites enter the blood after a mosquito bite, and then grow and multiply, causing malaria symptoms such as high fever and flu-like illness, including shaking chills, headache, muscle aches and tiredness. Hydroxychloroquine kills the malaria parasite, thereby preventing infection and the parasite from multiplying. This medicine is also effective for treating patients with the malaria infection.
  • Q fever Q fever is a bacterial infection transmitted from animals to humans, and is accompanied by symptoms such as headache, coughing, fever and muscle pain which are usually harmless and clear up without treatment. However in some people, it can cause serious or chronic problems and complications such as pneumonia, hepatitis or joint problems. Hydroxychloroquine kills the bacteria that cause Q fever. Treatment of Q fever often consists of a combination of hydroxychloroquine plus the antibiotic medicine doxycycline.
  • Lupus erythematosus (LE) This is a chronic autoimmune disease that can cause inflammation and pain in any part of the body, including the skin, joints and/or organs. LE often manifests itself in flares, causing flu-like symptoms.cHydroxychloroquine reduces the inflammation and associated symptoms.

How is hydroxychloroquine used?

The general instructions are for hydroxychloroquine tablets to be swallowed whole, with or after food. For Q fever or malaria, hydroxychloroquine tablets are prescribed as a course. It is important to finish the entire course as if not, some of the bacteria causing the infection may survive. If hydroxychloroquine tablets are used to treat rheumatoid symptoms, you should take into account that this medicine may take some time to reach full effect.

If you have forgotten to take a hydroxychloroquine tablet, you may take it as soon as you remember, unless it is almost time for your next scheduled dose, in which case skip the missed dose and continue your regular dosing schedule.

What doses are available?

Hydroxychloroquine is available in 200 mg tablets. Dosage will depend on the condition being treated. Always follow the doctor’s instructions. The general recommended dose for the following conditions is listed below.

Prevention of malaria

  • Adults:
    400 mg once a week on the same day of each week.
  • Children weighing 35 kg or more:
    6.5 mg per kg of body weight, with a maximum of 400 mg (taken once a week).

You should start taking hydroxychloroquine tablets one week before entering the malarial area and continue throughout your stay and for four to eight weeks after leaving the area.

Rheumatoid arthritis

  • Adults: 400 mg a day;
  • After several months of use, the starting dose may be switched to a maintenance dose of 200 mg a day.

Juvenile idiopathic arthritis

  • Children: dosage varies and is determined by a doctor based on body weight;
  • The maximum dosage in children is 6.5 mg per day per kg of body weight.

Lupus erythematosus

  • Adults: 400 mg – 600 mg a day;
  • After a while, the starting dose may be reduced to a maintenance dose of 200 mg – 400 mg a day.

Please consult a doctor about dosage of hydroxychloroquine tablets for conditions other than those listed above. For more information on the dosage of hydroxychloroquine tablets, see the package leaflet.

What are the side effects of hydroxychloroquine?

Hydroxychloroquine tablets may cause side effects, including:

  • Loss of appetite;
  • Nausea, diarrhoea, stomach pain;
  • Skin rash;
  • Headache;
  • Dizziness;
  • Eye problems.

Some side effects may impair your ability to drive. Stay out of traffic if you experience side effects that make you feel less alert than normal (e.g. dizziness or blurred vision). Consult a doctor if the side effects are severe or persistent. For a complete list of possible side effects from hydroxychloroquine tablets, see the package leaflet.

When not to use hydroxychloroquine?

Hydroxychloroquine is not suitable for everyone and should not be used if you:

  • Are allergic to hydroxychloroquine or any other ingredient in this medicine;
  • Have a pre-existing abnormality of the macula (maculopathy) or an eye condition called retinitis pigmentosa;
  • Have a condition called myasthenia gravis in which there is abnormal muscle weakness;
  • Weigh less than 35 kg.

If you are pregnant or breastfeeding, consult a doctor before using hydroxychloroquine.

There are warnings associated with this medicine for people with diabetes, certain hereditary heart conditions or impaired liver or renal function. Do not use this medicine without consulting a doctor first. It is possible that use of hydroxychloroquine tablets should be monitored closely by a doctor or that an adjusted dose is prescribed. For a complete list of warnings, see the package leaflet.

Can hydroxychloroquine be used in combination with other medicines?

Medicines known to interact with hydroxychloroquine include:

  • Certain antiarrhythmic medicines (e.g. digoxin);
  • Certain antidepressants and antipsychotic medicines;
  • Certain other antimalarial medicines.

For a complete list of interactions, see the package leaflet. The doctor will have a list of medicines that you should avoid mixing hydroxychloroquine with.

Where can I buy hydroxychloroquine?

Hydroxychloroquine tablets are available at pharmacies or online pharmacies.

Can I buy hydroxychloroquine without a prescription?

Hydroxychloroquine is a prescription-only medicine. This means you need a prescription from a registered doctor to buy hydroxychloroquine tablets.

Sources:

College ter Beoordeling van Geneesmiddelen. (1 August 2018). Hydroxychloroquinesulfaat CF 200 mg, filmomhulde tabletten – Geneesmiddeleninformatiebank – ARXX (Hydroxychloroquine sulfate CF 200 mg, film-coated tablets). Consulted on 20 March 2020 on https://www.geneesmiddeleninformatiebank.nl/ords/f? p=111:3::SEARCH:NO::P0_DOMAIN,P0_LANG,P3_RVG1:H,NL,114949

KNMP. (n.d.). Hydroxychloroquine – Apotheek.nl. Consulted on 20 March 2020 on https://www.apotheek.nl/medicijnen/hydroxychloroquine

Radboudumc. (n.d.). Hydroxychloroquine (Plaquenil®) bij reumatische aandoeningen hydroxychloroquine (Plaquenil®) for rheumatic conditions). Consulted on 20 March 2020 on https://www.radboudumc.nl/patientenzorg/behandelingen/hydroxychloroquine-plaquenil-bij-reumatische-aandoeningen ReumaNederland. (n.d.). Reumatoïde artritis (RA) (Rheumatoid arthritis (RA)). Consulted on 20 March 2020 on https://reumanederland.nl/reuma/vormen-van-reuma/reumatoide-artritis-ra/

Sint Maartenskliniek. (n.d.). Jeugdreuma (Juvenile idiopathic arthritis). Consulted on 20 March 2020 on https://www.maartenskliniek.nl/kinderzorg/kinderreumatologie/jeugdreuma

Zorginstituut Nederland. (n.d.). Hydroxychloroquine – FarmacotherapeutischKompas. Consulted on 20 March 2020 on https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/h/hydroxychloroquine#samenstelling

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