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      Malaria tablets: chloroquine

      Latest update: - Authors: Nele Alders, Ula Maniewski

      Chloroquine phosphate or hydroxychloroquine sulphate (Plaquenil®) 

      Indication

      Chloroquine phosphate or hydroxychloroquine sulphate (Plaquenil®) can be used in the prevention of malaria only in destinations where chloroquine resistance is not present.  Widespread resistance in most malaria-endemic countries has led to a decline in its use.

      Formulation

      • one adult tablet contains 200mg hydroxychloroquine sulphate (=155 mg base).

      Half- Life

      • 1–2 months

      Dosing schedule

      • adults: 300 mg base (500 mg salt) once a week
      • children >5kg: 5 mg/kg base (8.3mg/kg salt) orally once a week, up to maximum 300 mg base
      • duration: once a week, to start 1-2 weeks before entering risk zone and take until 28 days after leaving.

      Protection

      • chloroquine-resistant P. falciparum malaria is widespread (effectively universal), but it remains effective against most P. vivax, all P. ovale, P. knowlesi and virtually all P. malariae
      • chloroquine-resistant P. vivax is found in the Indonesian archipelago, the Malay Peninsula, including Myanmar, and eastward to Southern Vietnam, and may have spread further

      Contra- indications

      • convulsions/ epilepsy
      • concomitant use with amiodarone (ventricular arrhythmias), ciclosporin (ciclosporin toxicity), digoxin (increases plasmaconcentration), mefloquine (convulsions), moxifloxacin (ventricular arrhythmias)

      Precautions

      • highly toxic in overdose and children are particularly susceptible
      • antacids can reduce the absorption of chloroquine so it should be taken with an interval of at least four hours

      Pregnancy and breastfeeding

      • can be used in pregnancy and during breastfeeding.

      Side effects

      • potential exacerbation of psoriasis and myasthenia gravis
      • severe hypoglycaemia in diabetics and non-diabetics
      • gastrointestinal disturbances
      • headaches
      • itching (especially in African descents)

      Advantages and disadvantages

      limited use due to increasing resistance

      Additional information

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