Hydroxychloroquine

What is the most important information I should know about hydroxychloroquine?

You should not use this medication if you are allergic to hydroxychloroquine, or if you have a history of vision changes or damage to your retina caused by hydroxychloroquine or similar anti-malaria medications.

Before using hydroxychloroquine, tell your doctor if you are allergic to any drugs, or if you have psoriasis, porphyria, liver disease, alcoholism, or glucose-6-phosphate dehydrogenase (G-6-PD) deficiency.

Call a poison control center at once and then seek emergency medical attention if you think you have used too much of this medicine. An overdose of hydroxychloroquine can be fatal, especially in children.

Take this medicine for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated.

Contact your doctor as soon as possible if you have been exposed to malaria, or if you have fever or other symptoms of illness during or after a stay in an area where malaria is common.

When treating lupus or arthritis, tell your doctor if your symptoms do not improve after 6 months of treatment.

If you take hydroxychloroquine long-term, your doctor may need to check your knee and ankle reflexes and also do blood tests on a regular basis to check for harmful side effects. Your vision may also need to be tested every 3 months. Do not miss any scheduled appointments.

Hydroxychloroquine should not be used for long-term treatment in children.

What is hydroxychloroquine?

Hydroxychloroquine is used to treat or prevent malaria, a disease caused by parasites. Parasites that cause malaria typically enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia.

Hydroxychloroquine is also used to treat symptoms of rheumatoid arthritis and discoid or systemic lupus erythematosus.

Hydroxychloroquine may also be used for other purposes not listed in this medication guide.

What should I discuss with my health care provider before taking hydroxychloroquine?

You should not use this medication if you are allergic to hydroxychloroquine, or if you have a history of vision changes or damage to your retina caused by hydroxychloroquine or similar anti-malaria medications.

Hydroxychloroquine should not be used for long-term treatment in children.

Before using hydroxychloroquine, tell your doctor if you are allergic to any drugs, or if you have:

• psoriasis;
• porphyria;
• liver disease;
• alcoholism; or
• glucose-6-phosphate dehydrogenase (G-6-PD) deficiency.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take hydroxychloroquine.

Your doctor will tell you if any of your medication doses need to be changed.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Malaria is more likely to cause death in a pregnant woman. If you are pregnant, talk with your doctor about the risks of traveling to areas where malaria is common.

It is not known whether hydroxychloroquine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take hydroxychloroquine?

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Take hydroxychloroquine with a meal or a glass of milk, unless your doctor tells you otherwise.

Hydroxychloroquine is sometimes given only once per week. Choose the same day each week to take this medication if you are on a weekly dosing schedule.

To prevent malaria: Start taking the medicine 2 weeks before entering an area where malaria is common. Continue taking the medicine regularly during your stay and for at least 8 weeks after you leave the area.

To treat malaria: Your doctor may recommend a single dose, or an high starting dose followed by a smaller dose 6 to 8 hours later for 2 days in a row. Follow your doctor's instructions.

Take this medicine for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated.

In addition to taking hydroxychloroquine, use protective clothing, insect repellents, and mosquito netting around your bed to further prevent mosquito bites that could cause malaria.

Contact your doctor as soon as possible if you have been exposed to malaria, or if you have fever or other symptoms of illness during or after a stay in an area where malaria is common.

When treating lupus or arthritis, hydroxychloroquine is usually given daily for several weeks or months. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 6 months of treatment.

If you take hydroxychloroquine long-term, your doctor may need to check your knee and ankle reflexes and also do blood tests on a regular basis to check for harmful side effects. Your vision may also need to be tested every 3 months. Do not miss any scheduled appointments.

No medication is 100% effective in treating or preventing all types of malaria. For best results, keep using the medication as directed. Talk with your doctor if you have fever, vomiting, or diarrhea during your treatment.

Store hydroxychloroquine at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Call a poison control center at once and then seek emergency medical attention if you think you have used too much of this medicine. An overdose of hydroxychloroquine can be fatal, especially in children.

Treatment of a hydroxychloroquine overdose must be started quickly. You may be told to induce vomiting right away (at home, before transport to an emergency room). Ask the poison control center how to induce vomiting in the case of a hydroxychloroquine overdose.

Overdose symptoms may include headache, drowsiness, vision changes, slow heart rate, chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, seizure (convulsions), shallow breathing, or breathing that stops.

What should I avoid while taking hydroxychloroquine?

Follow your doctor's instructions about any restrictions on food, beverages, or activity while you are using hydroxychloroquine.

What are the possible side effects of hydroxychloroquine?

Some people taking this medication over long periods of time or at high doses have developed irreversible damage to the retina of the eye. Stop taking hydroxychloroquine and call your doctor at once if you have trouble focusing, if you see light streaks or flashes in your vision, or if you notice any swelling or color changes in your eyes.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• muscle weakness, twitching, or uncontrolled movement;
• loss of balance or coordination;
• blurred vision, light sensitivity, seeing halos around lights;
• pale skin, easy bruising or bleeding;
• confusion, unusual thoughts or behavior; or
• seizure (convulsions).

Less serious side effects may include:

• headache, ringing in your ears;
• spinning sensation;
• nausea, vomiting, stomach pain;
• loss of appetite, weight loss;
• mood changes, feeling nervous or irritable;
• skin rash or itching; or
• hair loss.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect hydroxychloroquine?

Before taking hydroxychloroquine, tell your doctor if you are also using any medications that can have side effects on the liver, such as:

• acetaminophen (Tylenol);
• cancer medications;
• tuberculosis medications;
• birth control pills or hormone replacement therapy;
• arthritis medications such as auranofin (Ridaura), aurothioglucose (Solganol), or methotrexate (Rheumatrex);
• an ACE inhibitor such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), or quinapril (Accupril);
• an antibiotic such as dapsone, erythromycin (E-Mycin, E.E.S., Ery-Tab, Erythrocin), fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), rifampin (Rifadin, Rifamate, Rimactane), or troleandomycin (Tao);
• cholesterol medications such as niacin (Advicor), atorvastatin (Lipitor), lovastatin (Altocor, Mevacor), simvastatin (Zocor), and others;
• HIV/AIDS medications such as lamivudine (Combivir, Epivir), abacavir/lamivudine/zidovudine (Trizivir), nevirapine (Viramune), tenofovir (Viread), or zidovudine (Retrovir);
• an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), and others; or
• seizure medications such as carbamazepine (Carbatrol, Tegretal), phenytoin (Dilantin), felbamate (Felbatol), valproic acid (Depakene).

This list is not complete and there may be other drugs that can interact with hydroxychloroquine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about hydroxychloroquine.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2003 Cerner Multum, Inc. Version: 3.10. Revision date: 03/24/2008.