Hydroxychloroquine Sulfate

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Hydroxychloroquine (Hydroxychloroquine Sulfate) is approved by the FDA to treat autoimmune conditions like rheumatoid arthritis & systemic lupus erythematosus, as well as malaria. It is available in 200 mg tablets. For acute malaria, adults start with 800 mg, followed by 400 mg doses. For malaria prevention, adults take 400 mg weekly. For autoimmune conditions, the dose varies, but the maximum is 400 mg daily. Hydroxychloroquine works by modulating immune responses and reducing inflammation. Common side effects include dizziness, upset stomach, and nausea. It should be stored below 30°C and kept away from children and pets. Consult your doctor for potential drug interactions and alternatives.

Product Overview

Hydroxychloroquine is a versatile medication primarily used for treating autoimmune conditions like systemic lupus erythematosus and rheumatoid arthritis, as well as for the treatment and prevention of malaria. The medication comes in 200 mg tablets and has specific dosage regimens depending on the condition being treated. For adults with acute malaria, the initial dose is 800 mg, followed by 400 mg doses 6-8 hours later and for the next two days. For malaria prevention, adults typically take 400 mg once weekly, starting two weeks before potential exposure and continuing for 4-6 weeks after.

In treating autoimmune conditions, the initial dose for adults is 400 mg daily, divided into smaller doses, with a maintenance dose of 200-400 mg daily, not exceeding 6.5 mg per kg of body weight or 400 mg daily. Hydroxychloroquine works by modulating the immune system & reducing inflammation through various mechanisms, including inhibiting antigen processing and cytokine production.

Common side effects include dizziness, upset stomach, nausea, headache, and fatigue. The medication should be stored at temperatures below 30°C & kept out of reach of children and pets, and unused medicine should be disposed of properly. It’s important to consult your doctor regarding potential drug interactions, as Hydroxychloroquine can interact with various medications, such as cyclosporine and certain antacids. Take any alternatives should only be taken under the guidance and instructions of a healthcare provider to avoid serious side effects.

Uses of Hydroxychloroquine

• Autoimmune Conditions (ex, Rheumatoid arthritis & Systemic lupus erythematosus)
• Malaria

Benefits of Hydroxychloroquine

• Effective in treating autoimmune diseases like Sjögren’s syndrome, rheumatoid arthritis, and lupus.
• Helps reduce inflammation, pain, and joint damage associated with these conditions.
• May prevent or reduce the risk of flare-ups in lupus patients.
• Can help control skin rashes and lesions in lupus and dermatomyositis.
• Has fewer side effects compared to other disease-modifying antirheumatic drugs (DMARDs).
• Can be used as a long-term treatment for autoimmune disorders.
• May have a steroid-sparing effect, reducing the need for high-dose corticosteroids.
• Relatively inexpensive and widely available as a generic medication.
• Can be safely used during pregnancy for the management of certain autoimmune conditions.
• Potential benefits in treating or preventing certain types of malaria.
• May have antiviral and anti-inflammatory properties useful in managing COVID-19 (still under investigation).
• Generally well-tolerated when used at recommended doses and monitored for potential side effects.

Side Effects of Hydroxychloroquine

Common side effects of Hydroxychloroquine may include:

• Upset stomach
• Nausea
• Dizziness
• Headache
• Fatigue

[Note: This list is not exhaustive, if you notice any other symptoms that are not mentioned above, consult your doctor immediately.]

Hydroxychloroquine Dosage

Forms & Strengths

It comes in the form of oral tablets and has a strength:

• Hydroxychloroquine 200 mg tablets

Recommended Dosages

Acute Malaria

For Adults:

• Initial Dose: 800 mg.
• Follow-up Dose: 400 mg, taken 6-8 hours after the initial dose.
• Subsequent Doses: 400 mg each day for the next 2 days.

For Children:

• Initial Dose: 13 mg per kg of body weight.
• Follow-up Dose: 6.5 mg per kg, taken 6 hours after the initial dose.
• Subsequent Doses: Same dosage on the second and third days.

Prophylaxis of Malaria

For Adults:

• Recommended Dose: 400 mg once weekly.
• Timing: Start two weeks before potential exposure and continue the same dose for 4-6 weeks after exposure.

For Children:

• Recommended Dose: 6.5 mg per kg of body weight once weekly.
• Maximum Dose: 400 mg per dose.

Rheumatoid Arthritis or Systemic Lupus Erythematosus

For Adults:

• Initial Dose: 400 mg daily, divided into smaller doses.
• Maintenance Dose: 200-400 mg daily.
• Maximum Dose: 6.5 mg per kg of body weight daily or 400 mg daily, whichever is less.

For Children:

• Recommended Dose: Up to 6.5 mg per kg of body weight daily or 400 mg daily, whichever is less.

How to Take Hydroxychloroquine?

• Take Hydroxychloroquine tablets exactly as prescribed by your doctor.
• Swallow the tablet whole with a full glass of water.
• You can take it with or without food, but it’s important to be consistent.
• Don’t split, chew, or crush the tablet unless your doctor advises otherwise.
• Follow the dosing schedule provided by your primary health care giver.

Missed Dose 

If you forget to take a dose of Hydroxychloroquine, take it as soon as you remember. Do not take a double dose to make up for the missed one.

[Note: Do not take two doses of Hydroxychloroquine at the same time to compensate for a missed dose. This may increase your risk of experiencing side effects.]

Overdose

Contact your right away doctor if you notice any symptoms of an overdose that may include:

• Severe dizziness
• Fainting
• Irregular heartbeat
• Difficulty breathing

[Note: If you notice you have taken too much medication, call your local emergency number immediately.]

How Does Hydroxychloroquine Work?

Hydroxychloroquine works by modulating the immune system through a multi-step process. It infiltrates the lysosomes within antigen-presenting cells (APCs), elevating the lysosomal pH and impeding the processing of antigens, which are substances that initiate immune responses. By interfering with antigen processing, Hydroxychloroquine reduces the presentation of antigens to T cells, leading to decreased T cell activation. Additionally, the medication inhibits the production of crucial immune response signaling molecules or cytokines, such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). This inhibition further decreases the recruitment of inflammatory cells to sites of inflammation. 

Important Safety Precautions

Consult your doctor if you notice or are doing any of the following:

• Allergic Reactions
• Liver Function
• Kidney Function
• Blood Disorders
• Gastrointestinal Effects
• Photosensitivity
• Pregnancy and Breastfeeding
• Psychiatric Effects
• Driving and Operating Machinery

Storage 

• Hydroxychloroquine should be stored at temperatures below 30°C. 
• Keep the medication out of reach of children and pets. 
• Do not use any expired or damaged medicine. 
• Dispose of unused medicine properly; do not flush it down the toilet or throw it into the drain.

Hydroxychloroquine Interactions

Here are the medications that may interact with Hydroxychloroquine:

• Ciclosporin
• Mefloquine
• Famotidine
• Praziquantel
• Ranitidine
• Cimetidine
• Esomeprazole
• Omeprazole
• Lansoprazole
• Tetracycline
• Doxycycline
• Chloroquine
• Quinine
• Hydroxychloroquine
• Metronidazole

[Note: This list of interactions isn’t complete. Talk to your doctor if you notice any interaction with food, over-the-counter drugs, prescriptions, or supplements.]

Hydroxychloroquine Alternatives

• Advil (ibuprofen)
• Aleve (naproxen)
• Motrin (ibuprofen)
• Voltaren (diclofenac)
• Orudis (ketoprofen)
• Celebrex (celecoxib)
• Mobic (meloxicam)
• Feldene (piroxicam)
• Indocin (indomethacin)

[Note: Your healthcare provider will choose which Hydroxychloroquine alternative is best for you. Taking or consuming them by yourself may cause serious side effects.] 

Frequently Asked Questions

What is the major toxic effect of Hydroxychloroquine?

The major toxic effect of Hydroxychloroquine is damage to the retina. This happens because the drug binds to melanin in the retinal pigment epithelium (RPE) and affects the macular cones outside of the fovea. It inhibits lysosome activity and reduces the phagocytosis of shed photoreceptor outer segments, leading to an accumulation that can damage vision.

Can Hydroxychloroquine cause weight gain?

Yes, long-term use of Hydroxychloroquine can cause abnormal weight gain. This side effect is thought to be related to changes in gut microbiota, which are influenced by the medication.

How long can you safely take Hydroxychloroquine?

The duration of safe Hydroxychloroquine use depends on the condition being treated. If the medication is effective for some conditions, you may need to take it for several years or even for the rest of your life to manage symptoms.

Should I take Hydroxychloroquine at night or in the morning?

The usual dose of Hydroxychloroquine is between 200 to 400 mg per day, which equates to one or two tablets daily. If your dosage is two tablets per day, you can take them all at once or split the dose, taking one tablet in the morning and one in the evening.

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