From the Guidelines
Hydroxychloroquine is primarily used to prevent systemic lupus episodes and other autoimmune and inflammatory diseases 1. The typical dose for adults is 200-400 mg per day, taken orally, with a maximum daily dose of 600 mg.
Key Uses
- Malaria treatment: The recommended dose is 800 mg initially, followed by 400 mg at 6,24, and 48 hours after the initial dose.
- Autoimmune diseases: Hydroxychloroquine is used to treat conditions such as rheumatoid arthritis and lupus.
- COVID-19: Hydroxychloroquine has been investigated as a potential therapeutic agent, with some studies utilizing a dose of 400 mg twice daily for 5-10 days 1.
Important Considerations
- Cardiac toxicity: Hydroxychloroquine can cause cardiac conduction defects and prolonged QT interval, which can lead to clinically relevant arrhythmias 1.
- Liver toxicity: Hydroxychloroquine can cause liver injury, particularly in patients with hepatic diseases or those taking hepatotoxic drugs 1.
- Gastrointestinal adverse effects: Hydroxychloroquine can cause nausea, vomiting, abdominal pain, and diarrhea 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
- 1 Malaria Hydroxychloroquine sulfate tablets are indicated in adult and pediatric patients for the: Treatment of uncomplicated malaria due to Plasmodium falciparum, Plasmodium malariae, Plasmodium vivax, and Plasmodium ovale. Prophylaxis of malaria in geographic areas where chloroquine resistance is not reported 1.2 Rheumatoid Arthritis Hydroxychloroquine sulfate tablets are indicated for the treatment of acute and chronic rheumatoid arthritis in adults.
- 3 Systemic Lupus Erythematosus Hydroxychloroquine sulfate tablets are indicated for the treatment of systemic lupus erythematosus in adults. 1.4 Chronic Discoid Lupus Erythematosus Hydroxychloroquine sulfate tablets are indicated for the treatment of chronic discoid lupus erythematosus in adults.
The use of Hydroxychloroquine is for the:
- Treatment of uncomplicated malaria
- Prophylaxis of malaria in areas where chloroquine resistance is not reported
- Treatment of rheumatoid arthritis in adults
- Treatment of systemic lupus erythematosus in adults
- Treatment of chronic discoid lupus erythematosus in adults 2
From the Research
Uses of Hydroxychloroquine
- Hydroxychloroquine is used to treat conditions such as rheumatoid arthritis and systemic lupus erythematosus 3, 4, 5
- It has been used as an antimalarial for many years, and its immunomodulatory, hypolipidemic, hypoglycemic, and antithrombotic properties make it a valuable treatment for various autoimmune diseases 4, 5
- Hydroxychloroquine has been considered as a potential treatment for COVID-19, although its efficacy and safety for this use are still uncertain 3, 5, 6
- It has also been used to treat other systemic autoimmune diseases, such as Sjögren's syndrome, antiphospholipid syndrome, and dermatomyositis 4
- Additionally, hydroxychloroquine has been proposed as a potential treatment for systemic vasculitis, including ANCA vasculitis, Henoch-Schonlein purpura/IgA vasculitis, Takayasu's arteritis, and polyarteritis nodosa 7
Therapeutic Effects
- Hydroxychloroquine has been shown to reduce inflammatory pathways and Toll-like receptors activation, which contributes to its immunomodulatory effects 4
- It can improve cardiometabolic risk and reduce the risk of infections and thrombosis in patients with systemic lupus erythematosus 4
- Hydroxychloroquine can also improve joint inflammation in rheumatoid arthritis and reduce the risk of malignancies 4, 5
Safety Profile
- Hydroxychloroquine is generally well-tolerated, although it can cause gastrointestinal toxicities, glucose abnormalities, dermatologic reactions, and neuropsychiatric events 3, 5
- Long-term use of hydroxychloroquine can lead to retinopathy, neuromyotoxicity, and cardiotoxicity, including conduction abnormalities and cardiomyopathy 3, 6
- The risk of toxicity increases with long-term use or high doses of the drug, and patients with pre-existing retinal diseases or those who are predisposed to retinal diseases are at higher risk 6