Chloroquine phosphate oral solid dosage
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Tablets containing chloroquine phosphate (250 mg of chloroquine phosphate is equivalent to 155 mg chloroquine base).
Drugs List
Therapeutic Indications
Uses
Amoebic hepatitis
Lupus erythematosus
Malaria - prophylaxis
Malaria - treatment
Rheumatoid arthritis
Treatment of malaria
Prophylaxis and suppression of malaria
Treatment of amoebic hepatitis and abscess
Treatment of discoid and systemic lupus erythematosus
Treatment of rheumatoid arthritis
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
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 of if the infection is mixed.
If further attention is required to destroy parasites in the liver, to prevent relapse when treating P. vivax and P. ovale infections, follow with a course of primaquine.
Adults
Treatment of malaria (P. falciparum, P. malariae, P. vivax and P. ovale infections)
620mg (four tablets) taken as a single dose, followed by 310mg (two tablets) six hours later, and then 310mg (two tablets) daily for the following two days.
Prophylaxis and suppression of malaria
310mg (two tablets) once a week, taken on the same day of the week.
Commence treatment one week prior to exposure to risk and continue for four weeks after leaving the malarious area.
Treatment of amoebic hepatitis
620mg (four tablets) daily for two days, followed by 155mg (one tablet) twice daily for the following two or three weeks.
Treatment of lupus erythematosus
155mg (one tablet) twice daily for one or two weeks, followed by a maintenance dose of one tablet per day.
Treatment of rheumatoid arthritis
155mg (one tablet) daily.
Children
Treatment of malaria (P. falciparum, P. malariae, P. vivax and P. ovale infections)
10mg chloroquine base/kg as a single dose, followed by 5mg chloroquine base/kg six hours later, then 5mg chloroquine base/kg daily for two days.
Children aged 9 to 14 years:
Three tablets as a single dose, followed by one and a half tablets six hours later and then one and a half tablets daily for a further two days.
Children aged 5 to 9 years:
Two tablets as a single dose, followed by one tablet six hours later and then one tablet daily for a further two days.
Children aged 1 to 5 years:
One tablet as a single dose, followed by half a tablet six hours later and then half a tablet daily for a further two days.
The following alternative dosing schedule may be suitable for the treatment of malaria caused by P. vivax, P. ovale or P. malariae
10mg/kg (maximum 620mg) of chloroquine base as a single dose, followed by 5mg/kg (maximum 310mg) of chloroquine base 6 to 8 hours later and then 5mg/kg (maximum 310mg) of chloroquine base once daily for two days.
Prophylaxis and suppression of malaria
5mg chloroquine base/kg once per week on the same day each week.
Commence treatment one week prior to exposure to risk and continue for four weeks after leaving the malarious area. The dose must not exceed the adult dosage regardless of body weight.
OR
Children aged 9 to 15 years: One and a half tablets.
Children aged 5 to 9 years: One tablet.
Children aged 1 to 5 years: Half a tablet.
The following alternative dosing schedule may be suitable for the prophylaxis of malaria, started one week before entering endemic area and continuing for four weeks after leaving:
Children aged over 13 years (bodyweight over 45kg): 310mg chloroquine base once weekly.
Children aged 8 to 13 years (bodyweight 25kg to 45kg): 232.5mg chloroquine base once weekly.
Children aged 4 to 8 years (bodyweight 16.5kg to 25kg): 155mg chloroquine base once weekly.
Children aged 3 to 4 years (bodyweight 15kg to 16.5kg): 125mg chloroquine base once weekly.
Children aged 1 to 3 years (bodyweight 11kg to 15kg): 100mg chloroquine base once weekly.
Children aged 6 months to 1 year (bodyweight 8kg to 11kg): 75mg chloroquine base once weekly.
Children aged 6 weeks to 6 months (bodyweight 4.5kg to 8kg): 50mg chloroquine base once weekly.
Children aged up to 6 weeks (bodyweight under 4.5kg): 25mg chloroquine base once weekly.
The oral liquid preparation may more be suitable for young children. The separate monograph for the oral liquid preparation should be consulted for further information.
Patients with Renal Impairment
The Renal Drug Handbook makes the following dose suggestions:
Glomerular filtration rate (GFR) between 10 and 50ml/minute: Dose as in normal renal function
Glomerular filtration rate (GFR) less than 10ml/minute: Half the normal dose
Contraindications
Long QT syndrome
Torsade de pointes
Precautions and Warnings
Children under 1 year
Elderly
Family history of long QT syndrome
Breastfeeding
Diabetes mellitus
Electrolyte imbalance
Epileptic disorder
G6PD deficiency
Hepatic cirrhosis
Hepatic impairment
History of seizures
History of torsade de pointes
Myasthenia gravis
Porphyria
Pregnancy
Psoriasis
Renal impairment
Correct electrolyte disorders before treatment
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
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 therapy has been linked to foetal abnormalities such as vision loss, ototoxicity and cochlear-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 breastfeeding.
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 expressed in human breast milk but 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 pain
Abnormal liver function tests
Acute generalised exanthematous pustulosis
Aggravation of porphyria
Agranulocytosis
Anaphylactic reaction
Angioedema
Anxiety
Aplastic anaemia
Blindness
Blurred vision
Bone marrow depression
Cardiomyopathy
Confusion
Convulsions
Corneal opacities
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
Hepatitis
Hypersensitivity reactions
Hypoacusis
Hypoglycaemia
Hypotension
Insomnia
Interstitial lung disease
Lichen-planus type reaction
Liver function disturbances
Macular degeneration of colour vision
Maculopapular rash
Myopathy
Nausea
Nerve deafness
Neuromyopathy
Neutropenia
Optic atrophy scotomas
Ototoxicity
Pancytopenia
Personality change
Photosensitivity
Pigmentation of mucous membranes
Pigmentation of nails
Pigmented deposits in the eye
Prolongation of QT interval
Pruritus
Psychotic reactions
Purpura
Rash
Retinal damage (irreversible)
Seizures
Skin pigmentation changes
Stevens-Johnson syndrome
Thrombocytopenia
Tinnitus
Toxic epidermal necrolysis
Urticaria
Vasculitis (allergic)
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: Avloclor tablets. Alliance Pharmaceuticals Limited. Revised October 2016.
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
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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