Chloroquine phosphate oral liquid
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral liquid formulations of chloroquine phosphate (chloroquine phosphate 80mg/5ml is equivalent to chloroquine base 50mg/5ml).
Drugs List
Therapeutic Indications
Uses
Malaria - prophylaxis
Malaria - treatment
Treatment of malaria
Prophylaxis and suppression of malaria
For up to date advice on geographical resistance patterns and appropriate prophylaxis, current guidelines should be consulted.
Guidelines for Malaria Prevention from Public Health England specifically developed for travellers from the United Kingdom may be obtained from:
https://www.gov.uk/government/publications/malaria-prevention-guidelines-for-travellers-from-the-uk
Unlicensed Uses
Amoebic hepatitis
Lupus erythematosus
Rheumatoid arthritis
Treatment of discoid and systemic lupus erythematosus
Treatment of rheumatoid arthritis
Treatment of amoebic hepatitis and abscess
Dosage
Chloroquine is no longer recommended for the treatment of falciparum malaria due to widespread resistance, nor is it recommended if the infective species is unknown or if the infection is mixed.
Adults
Suppression/prophylaxis of malaria
In non-immune patients
300mg chloroquine base (30mls) to be taken once a week.
Commence treatment 2 weeks prior to exposure and continue for 4 weeks after leaving the malarious area.
In partially immune patients
150mg chloroquine base (15mls) to be taken every two weeks.
Treatment of malaria
In non-immune patients
600mg chloroquine base (60mls) as a single dose, followed by 300mg chloroquine base (30mls) six hours later, and then 300mg chloroquine base (30mls) once daily for two days.
In partially immune patients
600mg chloroquine base (60mls) as a single dose.
The following dosing schedules may also be suitable:
Treatment of non falciparum malaria
620mg of chloroquine base as a single dose, followed by 310mg of chloroquine base 6 to 8 hours later and then 310mg of chloroquine base once a day for two days.
If a radical cure is required to destroy parasites in the liver and thus prevent relapse when treating P.vivax and P.ovale infections, follow with a course of primaquine.
Treatment of lupus erythematosus (unlicensed)
150mg chloroquine base a day. Maximum daily dose of 2.5mg/kg chloroquine base.
Treatment of rheumatoid arthritis (unlicensed)
150mg chloroquine base a day. Maximum daily dose of 2.5mg/kg chloroquine base.
Children
Suppression/prophylaxis of malaria
In non-immune patients
Children aged 12 to 18 years: (See Dosage; Adult)
Children aged 9 to 12 years: 225mg chloroquine base (22.5mls) to 300mg chloroquine base (30mls) once a week.
Children aged 6 to 9 years: 150mg chloroquine base (15mls) to 225mg chloroquine base (22.5mls) once a week.
Children aged 3 to 6 years: 100mg chloroquine base (10mls) to 150mg chloroquine base (15mls) once a week.
Children aged 1 to 3 years: 75mg chloroquine base (7.5mls) to 100mg chloroquine base (10mls) once a week.
Children under 1 year old: 25mg chloroquine base (2.5mls) to 50mg chloroquine base (5mls) once a week.
Commence treatment 2 weeks prior to exposure and continue for 4 weeks after leaving the malarious area.
In partially immune patients
Children aged 12 to 18 years: (See Dosage; Adult)
Children aged 9 to 12 years: 112.5mg chloroquine base (11.25mls) to 150mg chloroquine base (15mls) every 2 weeks.
Children aged 6 to 9 years: 75mg chloroquine base (7.5mls) to 112.5mg chloroquine base (11.25mls) every 2 weeks.
Children aged 3 to 6 years: 50mg chloroquine base (5mls) to 75mg chloroquine base (7.5mls) every 2 weeks.
Children aged 1 to 3 years: 37.5mg chloroquine base (3.75mls) to 50mg chloroquine base (5mls) every 2 weeks.
Children under 1 year: 12.5mg chloroquine base (1.25mls) to 25mg chloroquine base (2.5mls) every 2 weeks.
The following alternative dosing schedule may be suitable for the prophylaxis of malaria:
Children aged 13 to 18 years (bodyweight over 45kg): 310mg chloroquine base (31mls) once a week.
Children aged 8 to 13 years (bodyweight 25kg to 45kg): 225mg chloroquine base (22.5mls) once a week.
Children aged 5 to 8 years (bodyweight 16.5kg to 25kg): 150mg chloroquine base (15mls) once a week.
Children aged 3 to 5 years (bodyweight 15kg to 16.5kg): 125mg chloroquine base (12.5mls) once a week.
Children aged 1 to 3 years (bodyweight 11kg to 15kg): 100mg chloroquine base (10mls) once a week.
Children aged 6 months to 1 year (bodyweight 8kg to 11kg): 75mg chloroquine base (7.5mls) once a week.
Children aged 6 weeks to 6 months (bodyweight 4.5kg to 8kg): 50mg chloroquine base (5mls) once a week.
Children aged 4 to 6 weeks (bodyweight under 4.5kg): 25mg chloroquine base (2.5mls) once a week.
Commence treatment 1 week prior to exposure and continue for 4 weeks after leaving the malarious area.
Treatment of malaria
In non-immune patients
Children aged 12 to 18 years: (See Dosage; Adult)
Children aged 9 to 12 years: 450mg chloroquine base (45mls) to 600mg chloroquine base (60mls) as a single dose, followed by 225mg chloroquine base (22.5mls) to 300mg chloroquine base (30mls) six hours later, and then 225mg chloroquine base (22.5mls) to 300mg chloroquine base (30mls) once daily for two days.
Children aged 6 to 9 years: 300mg chloroquine base (30mls) to 450mg chloroquine base (45mls) as a single dose, followed by 150mg chloroquine base (15mls) to 225mg chloroquine base (22.5mls) six hours later, and then 150mg chloroquine base (15mls) to 225mg chloroquine base (22.5mls) once daily for two days.
Children aged 3 to 6 years: 200mg chloroquine base (20mls) to 300mg chloroquine base (30mls) as a single dose, followed by 100mg chloroquine base (10mls) to 150mg chloroquine base (15mls) six hours later, and then 100mg chloroquine base (10mls) to 150mg chloroquine base (15mls) once daily for the following two days.
Children aged 1 to 3 years: 150mg chloroquine base (15mls) to 200mg chloroquine base (20mls) as a single dose, followed by 75mg chloroquine base (7.5mls) to 100mg chloroquine base (10mls) six hours later, and then 75mg chloroquine base (7.5mls) to 100mg chloroquine base (10mls) once daily for two days.
Children aged under 1 year: 50mg chloroquine base (5mls) to 100mg chloroquine base (10mls) as a single dose, followed by 25mg chloroquine base (2.5mls) to 50mg chloroquine base (5mls) six hours later, and then 25mg chloroquine base (2.5mls) to 50mg chloroquine base (5mls) once daily for two days.
In partially immune patients
Children aged 12 to 18 years: (See Dosage; Adult)
Children aged 9 to 12 years: 450mg chloroquine base (45mls) to 600mg chloroquine base (60mls) as a single dose.
Children aged 6 to 9 years: 300mg chloroquine base (30mls) to 450mg chloroquine base (45mls) as a single dose.
Children aged 3 to 6 years: 200mg chloroquine base (20mls) to 300mg chloroquine base (30mls) as a single dose.
Children aged 1 to 3 years: 150mg chloroquine base (15mls) to 200mg chloroquine base (20mls) as a single dose.
Children aged up to 1 year: 50mg chloroquine base (5mls) to 100mg chloroquine base (10mls) as a single dose.
The following dosing schedules may also be suitable:
Treatment of non falciparum malaria
10mg/kg of chloroquine base as a single dose (maximum 620mg), followed by 5mg/kg of chloroquine base (maximum 310mg) 6 to 8 hours later and then 5mg/kg of chloroquine base (maximum 310mg) once a day for two days.
Patients with Renal Impairment
The Renal Drug Handbook makes the following dose suggestions:
Glomerular filtration rate (GFR) between 10 and 50 ml/minute: Dose as in normal renal function
Glomerular filtration rate (GFR) less than 10 ml/minute: Half the normal dose
Contraindications
Hereditary fructose intolerance
Long QT syndrome
Torsade de pointes
Precautions and Warnings
Elderly
Family history of long QT syndrome
Breastfeeding
Diabetes mellitus
Electrolyte imbalance
Epileptic disorder
G6PD deficiency
Glucose-galactose malabsorption syndrome
Hepatic cirrhosis
Hepatic impairment
History of neurological disorder
History of seizures
History of torsade de pointes
Myasthenia gravis
Neurological disorder
Porphyria
Pregnancy
Psoriasis
Renal impairment
Severe gastrointestinal disorder
Correct electrolyte disorders before treatment
May exacerbate myasthenia gravis
Monitor for haemolysis in G6PD deficiency
Reduce dose in patients with a glomerular filtration rate below 10ml/min
Advice available from specialist unit for the use of this drug
Advise visual disturbances may affect ability to drive or operate machinery
Consider prevalence of resistance when prescribing
Drugs for malaria prophylaxis are not prescribable on the NHS
Contains hydroxybenzoate
Preparation contains sucrose
Perform ECG before and during treatment
Perform ophthalmological examination before therapy and 3-6 monthly
Monitor cardiac function during prolonged treatment
Monitor serum electrolytes
Monitor the elderly for optimum dosing
Perform blood counts on prolonged use of this treatment
Advise patient to report any symptoms of interstitial lung disease
Advise patient to report new visual problems and symptoms
May exacerbate psoriasis
May induce severe hypoglycaemia
Predisposition QT prolongation: Counsel patient on symptoms of arrhythmias
Advise of importance of avoiding mosquito bites
Advise patients of the warning signs of hypoglycaemia
Advise patients on the importance of taking treatment regularly
Consult Dr. if illness occurs within 1 year of return from malarious area
Although chloroquine may have a temporary effect on visual accommodation during short term treatment, irreversible retinal damage may occur with prolonged treatment and after treatment has been discontinued. Ophthalmological examinations should always be carried out before and regularly during prolonged treatment. Retinal damage is particularly likely to occur if:
- Continuous high doses have been given for longer than one year.
- The total dosage has exceeded 1.6 g/kg bodyweight (cumulative dose approximately 100 g).
- Patients receive chloroquine continuously at weekly intervals for more than three years.
Chloroquine may precipitate severe constitutional symptoms and an increase in the amount of porphyrins excreted in the urine.
Patients with a high alcohol intake are particularly at risk. The drug database for acute porphyria (NAPOS) class this drug as being possibly porphyrinogenic. It suggests chloroquine should only be used when no safer alternative is available.
Pregnancy and Lactation
Pregnancy
Use chloroquine with caution during pregnancy.
The manufacturer does not recommend using chloroquine during pregnancy. Available reports indicate that when used in high doses or on a long term basis, chloroquine has been linked to foetal abnormalities including visual loss, ototoxicity and cochlea-vestibular dysfunction.
Non-treatment of malaria can produce severe complications for mother and foetus including: maternal death, anaemia, abortion, stillbirth, prematurity, low birth weight, foetal distress. The choice of drug for malaria prophylaxis and treatment during pregnancy depends upon the local pattern of drug resistance, severity of malaria and the degree of pre-existing malaria immunity.
Lactation
Use chloroquine with caution during lactation.
The manufacturer advises caution if chloroquine is used during breastfeeding. Breastfeeding is not recommended in patients taking chloroquine long-term or at high doses e.g. for rheumatoid disease or lupus erythematosus. Available data indicates that chloroquine is excreted into milk at levels too low to harm the infant. The levels excreted are insufficient to provide the infant with protection against malaria. If appropriate, chemoprophylaxis should be administered to the infant.
Counselling
For oral administration to be taken after food.
When chloroquine sulfate is used for malaria prophylaxis warn travellers about the importance of avoiding mosquito bites, the importance of taking prophylaxis regularly, and the importance of an immediate visit to a doctor if they fall ill within 1 year and especially within 3 months of return.
Antacids may impair absorption, therefore antacids should be taken at least 2 hours before or 2 hours after administration with chloroquine.
Patients should be advised to discontinue the medication and seek immediate medical advice if they notice any deterioration in their vision which persists for more than 48 hours.
Advise patients to report symptoms of interstitial lung disease.
Ability to drive and operate machinery may be affected by side effects, in particular visual disturbances.
Side Effects
Abdominal cramps
Abnormal liver function tests
Aggravation of porphyria
Agranulocytosis
Allergic reaction
Anaphylactic reaction
Angioedema
Anxiety
Aplastic anaemia
Arrhythmias
Blindness
Blurred vision
Bone marrow depression
Cardiomyopathy
Confusion
Convulsions
Corneal opacities
Delirium
Depression
Diarrhoea
Diplopia
Disturbances in accommodation
Drug rash with eosinophilia and systemic symptoms (DRESS)
ECG changes
Erythema multiforme
Exacerbation of myasthenia gravis
Exacerbation of psoriasis
Exfoliative dermatitis
Gastro-intestinal disturbances
Haemolysis
Hair loss
Hallucinations
Headache
Hepatic damage
Hepatic impairment
Hepatitis
Hypoacusis
Hypoglycaemia
Hypotension
Insomnia
Interstitial lung disease
Liver function disturbances
Macular degeneration of colour vision
Maculopapular rash
Myopathy
Nausea
Nerve deafness
Neuromyopathy
Neutropenia
Optic atrophy scotomas
Ototoxicity
Pancytopenia
Photosensitivity
Pigmentation of mucous membranes
Pigmentation of nails
Pigmented deposits in the eye
Polyneuropathy
Prolongation of QT interval
Pruritus
Psychotic reactions
Purpura
Rash
Retinal damage (irreversible)
Retinopathy
Seizures
Skin pigmentation changes
Stevens-Johnson syndrome
Suicidal tendencies
Thrombocytopenia
Tinnitus
Torsades de pointes
Toxic epidermal necrolysis
Urticaria
Ventricular fibrillation
Ventricular tachycardia
Visual field defects
Vomiting
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: April 2020
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.
Summary of Product Characteristics: Malarivon syrup. Wallace Manufacturing Chemists. Revised March 2020.
The Renal Drug Handbook. Fifth Edition (2019) ed. Ashley, C. and Dunleavy, A. Radcliffe Publishing Ltd, London.
NICE - Evidence Services
Available at: www.nice.org.uk
Last accessed: 08 April 2020
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/
Chloroquine Last revised: 31 October 2018
Last accessed: 08 April 2020
The Norwegian Porphyria Centre (NAPOS).
Available at: https://www.drugs-porphyria.org
Last revised: 22 September 2018
Last accessed: 08 April 2020
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