HydroxychloroquineHydroxychloroquine Sulfate

About Hydroxychloroquine

Hydroxychloroquine is a 4-aminoquinoline antimalarial; how it reduces inflammation and immune activity in rheumatoid arthritis and lupus is not fully known. The label covers uncomplicated malaria caused by Plasmodium falciparum, malariae, vivax and ovale in adults and children, and malaria prevention where chloroquine resistance is not reported; it is not recommended for complicated or chloroquine-resistant malaria, and vivax and ovale need an added 8-aminoquinoline drug to prevent relapse. Adults take 400 mg once a week for prevention, from 2 weeks before travel until 4 weeks after leaving, and for treatment 800 mg, then 400 mg at 6, 24 and 48 hours; children are dosed by weight. In adults it also treats rheumatoid arthritis (400 to 600 mg a day at first, then 200 to 400 mg a day), systemic lupus erythematosus and chronic discoid lupus (200 or 400 mg a day). For rheumatoid arthritis the label says its action is cumulative and may take weeks to months to reach full effect.

There is no boxed warning; anyone allergic to 4-aminoquinolines must not take it. Fatal and life-threatening heart toxicity, including cardiomyopathy, has been reported, and it can prolong the QT interval and cause ventricular arrhythmias such as torsades de pointes. It is avoided with QT prolongation or its risk factors (heart failure, a past heart attack, a heart rate under 50, earlier ventricular arrhythmias, uncorrected low potassium or magnesium), is not recommended with other QT-prolonging drugs, and its recommended dose is not exceeded. Retinal damage can be irreversible and relates to total dose and duration; risk rises with daily doses of 5 mg/kg of actual body weight or more, use beyond five years, kidney impairment, tamoxifen and macular disease. It can cause severe, potentially life-threatening low blood sugar, with or without diabetes medicines. Other warnings cover severe skin reactions, worsening psoriasis and porphyria, low blood counts, hemolysis in G6PD deficiency, muscle weakness or nerve damage, suicidal thoughts and other psychiatric effects (usually in the first month), and kidney toxicity.

A baseline eye exam is recommended within the first year. People at higher risk need yearly exams, while for others yearly retinal exams can usually wait until five years of treatment. Plaquenil 200 mg tablets are taken with food or milk and not crushed or divided; because one tablet exceeds the dose for children under 31 kg, its label does not recommend it for them. Sovuna, approved in 2022 in 200 mg and scored 300 mg tablets, is labeled for malaria in children from 23 kg. Decades of use have not identified a risk of major birth defects or miscarriage, a pregnancy registry exists, and the drug passes into breast milk at low levels without reported harm to infants.

Taking Hydroxychloroquine

How to take it

With food or milk, without crushing the tablets; Plaquenil tablets are not divided either. For malaria prevention, take it once a week on the same day each week, from 2 weeks before travel until 4 weeks after leaving the area. For lupus or rheumatoid arthritis, take it once or twice a day as prescribed.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in a tight, light-resistant container, out of reach of children.

Interactions to know about

It is not recommended with other drugs that prolong the QT interval. Insulin and other diabetes medicines may need lower doses; digoxin and cyclosporine levels are watched; cimetidine and rifampin are avoided; mefloquine may raise seizure risk; it may weaken antiepileptic drugs; and combined use with methotrexate may increase side effects. Antacids and kaolin are taken at least 4 hours apart from it.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Hydroxychloroquine differs from pharmacy to pharmacy

Generic 200 mg tablets come from many makers, while the 100, 300 and 400 mg strengths have few, so quotes differ by each pharmacy’s fee and markup, by whether hydroxychloroquine is on its flat-price generic list, and by the strength written.

A prescription that names Plaquenil and blocks substitution is filled with the brand, and one written for Sovuna is filled with Sovuna unless the prescriber changes it.

Ways to pay less for Hydroxychloroquine without insurance

• Once the dose is settled for lupus or rheumatoid arthritis, ask the prescriber whether a ninety-day supply suits you.
• Check that the prescription allows a generic, unless the prescriber has a reason to require Plaquenil or Sovuna.
• If your daily dose is written as more than one tablet, ask the prescriber whether one tablet of another strength would give the same dose.
• For malaria prevention, ask for a prescription that covers the whole schedule, from 2 weeks before travel to 4 weeks after you leave.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Hydroxychloroquine

1. 1.When should I have my eye exams, and what will they check?
2. 2.Do any of my other medicines also affect my heart rhythm?
3. 3.How will I recognize low blood sugar, and what should I do?
4. 4.How far apart should I take it and my antacid?

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