Chloroquine

Paul G. Auwaerter, M.D., Edina Avdic, Pharm.D.
Pediatric Dosing Author: Bethany Sharpless Chalk, Pharm.D., BCPPS

INDICATIONS

FDA

  • Malaria prophylaxis and treatment (caused by P. vivax, P. malariae, P. ovale, and chloroquine-susceptible strains of P. falciparum)
  • Amebic liver abscess

NON-FDA APPROVED USES

FORMS

brand name

preparation

manufacturer

route

form

dosage^

cost*

Aralen phosphate

Chloroquine phosphate

~Various generic manufacturers

PO

tab

250 mg

$2.82

PO

tab

500 mg

$7.32-14.75

*Prices represent the specified cost per unit and the "Average Wholesale Price" (AWP).
^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

500 mg of chloroquine phosphate is equivalent to 300 mg chloroquine base. 250 mg of chloroquine phosphate is equivalent to 150 mg chloroquine base.

Malaria

  • Treatment: 1 g (=600 mg base) once, then 500 mg (=300 mg base) at 6 h, 24 h and 48 h.[23]
  • Prophylaxis (in chloroquine-sensitive regions): 500 mg (=300mg base) PO starting one week before entry, continuing once weekly, and then four weeks after leaving the endemic region.

Amoebiasis

  • 1 g (=600 mg base) daily for 2 days, followed by 500 mg (=300 mg base) daily for 2-3 weeks. Treatment is usually combined with an effective intestinal amebicide.[24]

ADULT RENAL DOSING

DOSING IN HEMODIALYSIS

No data

DOSING IN PERITONEAL DIALYSIS

No data

DOSING IN RENAL REPLACEMENT THERAPY

No data

Other Adult Renal Dosing Information

No renal adjustment is recommended, however use caution in patients with renal impairment due to very long half-life. Close monitoring for adverse events is recommended.

PEDIATRIC DOSING

USUAL PEDIATRIC DOSING

500 mg of chloroquine phosphate is equivalent to 300 mg chloroquine base.

  • Malaria:
    • Treatment: 16.6 mg/kg chloroquine phosphate (max initial dose of chloroquine phosphate = 1000 mg), followed by 8.3 mg/kg chloroquine phosphate (max subsequent dose of chloroquine phosphate= 500 mg) administered at 6, 24, and 48 hours after the initial dose (total of 4 doses).
    • Prophylaxis (in chloroquine-sensitive regions): 8.3 mg/kg chloroquine phosphate (max dose of chloroquine phosphate = 500 mg) PO starting 1-2 weeks prior to entry, continue once weekly and then 4 weeks after leaving the endemic region.
  • Extraintestinal amebiasis, liver abscess: 16.6 mg/kg chloroquine phosphate (max initial dose of chloroquine phosphate = 1000 mg) once daily for 21 days.

PEDIATRIC RENAL DOSING

No dosage adjustments are provided per the manufacturer, however renal dosing adjustments are recommended in adult patients. Monitor patients with renal dysfunction carefully for adverse effects.

ADVERSE DRUG REACTIONS

GENERAL

  • Chloroquine is contraindicated for patients with preexisting retinopathy of the eye or known hypersensitivity to the 4-aminoquinoline compound.
    • Retinopathy is one of the most serious adverse events associated with chloroquine, and it is NOT reversible but appears not to be an issue with short-term therapy.
      • Major risk factors for retinopathy include 1) high dosage (>2.3 mg/kg base of actual body weight), 2) long duration (>5 years), 3) pre-existing renal disease, 4) concomitant use of tamoxifen, and 5) pre-existing retinal/macular disease.[13]
      • The American Academy of Ophthalmology recommends screening for chloroquine-related retinopathy: examination before therapy initiation to rule out preexisting maculopathy and annual screening after 5 years for patients on acceptable doses and without major risk factors.[13]
  • Using chloroquine in patients with psoriasis may precipitate a severe attack of psoriasis.

COMMON

  • Gastrointestinal complaints: diarrhea, anorexia, nausea, abdominal cramps, vomiting, loss of appetite
  • Skin rash, pruritus

OCCASIONAL

  • Dizziness, headache, confusion
  • Abnormal liver function tests
  • Sensory-motor disorders
  • Nervousness
  • Alopecia
  • Visual disturbances
  • Chloroquine can prolong the PR, QRS, and QTc intervals, especially in patients with underlying risk factors, or it can be used in combination with other QT-prolonging drugs.
    • In one systemic review of cardiac toxicity (n=127), conduction disorders were the most common. The median duration of treatment was 7 years (minimum 3 days—max of 35 years).[10]

RARE

  • Cardiomyopathy has been rarely reported with high daily dosages of chloroquine.
  • Severe hypoglycemia, especially in diabetics on antidiabetic medications
  • Bone marrow suppression
  • Fulminant hepatic failure
  • Extrapyramidal reactions
  • Suicidal behavior
  • Retinal toxicity
  • Pigmentary changes in skin and mucous membranes, bleaching of hair, and alopecia
  • Hemolytic anemia in patients with G6PD deficiency- the manufacturer recommends using caution. However, one retrospective review no hemolysis was reported in patients who were G6PD deficient and were on hydroxychloroquine long term.[12]

DRUG INTERACTIONS

Drug-to-Drug Interactions

Drug

Effect of Interaction

Recommendations/Comments

Antacids

Antacids may reduce the absorption of chloroquine

Separate co-administration by 4-hour interval

Antidiabetic drugs and insulin

Chloroquine may enhance the effects of a hypoglycemic treatment

Reduction in doses of antidiabetic agents may be needed

Antiepileptic drugs

The activity of antiepileptic drugs might be impaired if co-administered with chloroquine.

Monitor for seizures if coadministration can not be avoided

Cimetidine

Cimetidine can inhibit the metabolism of chloroquine and increase serum concentrations.

Avoid combination if possible or monitor for toxicity if the combination can not be avoided.

Cyclosporin

An increased plasma cyclosporine level was reported with co-administration with hydroxychloroquine, which would also be expected for chloroquine

Monitor cyclosporin serum levels in patients receiving
concomitant treatment

Digoxin

Chloroquine may increase digoxin serum levels

Monitor digoxin serum levels in patients receiving
concomitant treatment

Mefloquine

Co-administration of chloroquine with other antimalarials known to lower the convulsion threshold (e.g., mefloquine) may increase the risk of convulsions.

Avoid co-administration if possible or monitor for seizures if coadministration can not be avoided.

Praziquantel

Chloroquine has been reported to reduce the bioavailability of praziquantel.

Avoid coadministration

Rabies vaccine

Chloroquine may decrease rabies-neutralizing antibody titer with co-administration[22]

Avoid coadministration

SPECTRUM

RESISTANCE

  • Chloroquine is ineffective against chloroquine-resistant strains of P. falciparum and is not active against the exo-erythrocytic forms of P. vivax, P. ovale and P. malariae.
  • Resistance to chloroquine emerged in Thailand and Colombia in the late 1950s and then in New Guinea and eastern sub-Saharan Africa in the 1970s.
    • Today, resistance P. falciparum occurs everywhere except in Central America, west of the Panama Canal, Haiti, the Dominican Republic, and most of the Middle East.
  • Resistance to chloroquine by P. vivax has also emerged in New Guinea, Indonesian archipelago and sporadic in the rest of Asia, and rare in South America.
  • The latest information on chloroquine resistance in the world can be found www.wwarn.org

PHARMACOLOGY

MECHANISM

  • Chloroquine belongs to a 4-aminoquinoline antibacterial class. It is a weak base and may exert its effect by concentrating the acid vesicles of the parasite and by inhibiting the polymerization of heme. However, the exact mechanism against Plasmodium is unknown.
  • It accumulates in lymphocytes and macrophages, resulting in anti-inflammatory properties, which is the main reason for its use in rheumatoid arthritis and lupus erythematosus diseases.

PHARMACOKINETIC PARAMETERS

Absorption

89%

Metabolism and Excretion

Hepatic metabolism to desethyl metabolite. 41- 47% of unchanged drug and 7-12% of the metabolite are excreted unchanged in the urine (detected in urine up to 119 days after a single dose).

Protein Binding

50-65%

Cmax, Cmin, and AUC

26 mg of chloroquine base in four divided doses over 72 hours resulted in levels above 1mmol/L (note that the mean toxic dose is 4.7 mg/dl).

T1/2

Days-2 months[21]

Distribution

  • Extensive Vd, up to 800 L/kg
  • It is widely distributed in body tissues such as the eyes, brain, heart, kidney, liver and lungs, and high levels are attained in erythrocytes.

DOSING FOR DECREASED HEPATIC FUNCTION

Use with caution in patients with hepatic impairment. The manufacturer recommends no dosing adjustment, but close monitoring for adverse events is recommended.

PREGNANCY RISK

  • The use of chloroquine in pregnancy without an increase in the rate of birth defects has been reported in the literature. In a report of 169 infants exposed to in utero to 300 mg of chloroquine weekly throughout pregnancy did not result in increased teratogenicity. Chloroquine is the antimalarial prophylaxis considered probably safe in pregnancy, and hydroxychloroquine is generally recommended for pregnant patients with an autoimmune disease.
  • Embryonic deaths and ocular malformations in the offspring have been reported when pregnant rats received large doses of chloroquine.

BREAST FEEDING COMPATIBILITY

Chloroquine is excreted in breast milk (2.8%). The American Academy of Pediatrics considers chloroquine to be compatible with breastfeeding, but exposure inadequate for infant chemoprophylaxis. Separate chemoprophylaxis for the infant is required.

COMMENTS

Malaria

  • Chloroquine is recommended for treating uncomplicated malaria caused by chloroquine-sensitive P. falciparum or P. vivax and P. malariae, P. knowlesi, and P. ovale from all regions. For the treatment of P. ovale and. P. vivax is used in combination with primaquine phosphate or tafenoquine. Primaquine and tafenoquine are needed to eradicate hypnozoites in the liver to prevent relapses.[9]
  • It is also one of the agents that can be used for malaria prophylaxis in select regions (Central America west of Panama Canal, Haiti, and the Dominican Republic). It must be started 1-2 weeks before travel, during travel (weekly) and for 4 weeks after leaving an endemic area.

Q-fever, Whipple’s disease

  • Chloroquine is used in combination with doxycycline for the treatment of C. burnetii and T. whipplei; it has been shown to restore doxycycline bactericidal activity against C. burnetii[20] and T. whipplei[19]in vitro (doxycycline, when used alone, is bacteriostatic against these pathogens). Hydroxychloroquine is preferred over chloroquine due to its long-term improved tolerance.

Efficacy against other viruses

  • Chloroquine has been found to have in vitro activity against many viruses. However, clinical trials failed to demonstrate efficacy against influenza[16], dengue[17], ebola[14], and SARS-CoV-2. [3][6][2][8][7]
  • SARS-CoV-2
    • Initial interest early based on in vitro findings has not borne out when studied, including the causing drug hydroxychloroquine, which also had enhanced mortality[5].

Amoebiasis

  • Rarely used today due to the availability of other highly effective agents that are better tolerated (e.g., metronidazole).

References

  1. Biswas M, Sukasem C. Pharmacogenomics of chloroquine and hydroxychloroquine: current evidence and future implications. Pharmacogenomics. 2023;24(15):831-840.  [PMID:37846548]

    Comment: CQ utilizes CYP2C8, CYP3A4/5 and CYP2D6; with the drug substrate, effects are reviewed with available information. Authors point out that a considerable proportion of the world population predicted to be ultra-rapid or poor metabolizers are identified as having high-risk phenotypes for either therapeutic failure or adverse drug reactions

  2. Naggie S, Milstone A, Castro M, et al. Hydroxychloroquine for pre-exposure prophylaxis of COVID-19 in health care workers: a randomized, multicenter, placebo-controlled trial Healthcare Worker Exposure Response and Outcomes of Hydroxychloroquine (HERO-HCQ). Int J Infect Dis. 2023;129:40-48.  [PMID:36682681]

    Comment: The HERO-HCQ was a multicenter, double-blind, randomized, placebo-controlled study that included adult healthcare workers with potential exposure to patients with COVID-19. Subjects were randomized to receive placebo or hydroxychloroquine at a dose of 600 mg twice daily on day 1, followed by 400 mg daily for 29 days. The primary outcome was a composite of confirmed or suspected clinical infection with COVID-19 through 30 days, which the authors did not find a significant difference between the placebo and hydroxychloroquine groups (7.8% vs. 6.0%, respectively; 95% Cl –4.60-0.87; p=0.20). There was no significant difference in PCR-confirmed, symptomatic COVID-19 between the placebo and hydroxychloroquine groups (0.4% vs. 0.9%, respectively; 95% Cl –1.54-0.50; p=0.34). Furthermore, no significant difference in the incidence of serious adverse events to day 60 was noted between the two groups.

  3. Dubée V, Roy PM, Vielle B, et al. Hydroxychloroquine in mild-to-moderate coronavirus disease 2019: a placebo-controlled double blind trial. Clin Microbiol Infect. 2021;27(8):1124-1130.  [PMID:33813110]

    Comment: The HYCOVID trial was a double-blind, placebo-controlled, randomized study that included adult patients with PCR-confirmed COVID-19 infections 2 days before randomization. Patients were randomized to receive either placebo or hydroxychloroquine at the dose of 400 mg PO twice daily on day 1, followed by 200 mg PO twice daily for 8 days. The primary endpoint was the rate of the composite endpoint of mortality and initiation of invasive mechanical ventilation within 14 days following randomization, which the authors did not find a significant difference between the placebo and hydroxychloroquine groups (6.5% vs. 7.3%, respectively; relative risk 1.12; 95% Cl 0.45-2.80, p=0.82).

  4. Rajasingham R, Bangdiwala AS, Nicol MR, et al. Hydroxychloroquine as Pre-exposure Prophylaxis for Coronavirus Disease 2019 (COVID-19) in Healthcare Workers: A Randomized Trial. Clin Infect Dis. 2021;72(11):e835-e843.  [PMID:33068425]

    Comment: This randomized, double-blind, placebo-controlled clinical trial included adult healthcare workers with ongoing exposure to persons with COVID-19. Subjects were randomized to receive either placebo or hydroxychloroquine at a dose of 400 mg twice, separated by 6-8 hours, followed by 400 mg once weekly or 400 mg twice weekly for 12 weeks. The primary endpoint was a rate of PCR-confirmed COVID-19, which the authors did not find a significant difference between placebo and once weekly hydroxychloroquine (1.2% vs 0.8%, respectively; hazard ratio 0.65; 95% Cl 0.18-2.32), or twice weekly hydroxychloroquine (1.2% vs. 1.4%, respectively; hazard ratio 1.18; 95% Cl 0.40-3.51).

  5. Axfors C, Schmitt AM, Janiaud P, et al. Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nat Commun. 2021;12(1):2349.  [PMID:33859192]

    Comment: A study of available trial information found that the OR all-cause mortality for hydroxychloroquine was 1.11 (95% CI: 1.02, 1.20; I² = 0%; 26 trials; 10,012 patients) and for chloroquine was 1.77 (95% CI: 0.15, 21.13, I² = 0%; 4 trials; 307 patients). Enhanced mortality was seen with HCQ, not so with chloroquine, but the drug had no benefit.

  6. Mitjà O, Corbacho-Monné M, Ubals M, et al. A Cluster-Randomized Trial of Hydroxychloroquine for Prevention of Covid-19. N Engl J Med. 2021;384(5):417-427.  [PMID:33289973]

    Comment: The BCN-PEP-CoV2 trial was an open-label, randomized trial that included asymptomatic adults who had a recent history of close-contact exposure to a PCR-confirmed case patient with COVID-19 and had no COVID-19-like symptoms during the 2 weeks before enrollment. Subjects are randomized to either the standard-of-care or hydroxychloroquine group at a dose of 800 mg on day 1 followed by 400 mg daily for 6 days. The primary endpoint was the rate for PCR-confirmed, symptomatic COVID-19 episodes, in which the authors did not find a significant difference between the standard-of-care hydroxychloroquine groups (5.7% vs 6.2%, respectively; risk ratio 0.86; 95% Cl 0.52-1.42).

  7. WHO Solidarity Trial Consortium, Pan H, Peto R, et al. Repurposed Antiviral Drugs for Covid-19 - Interim WHO Solidarity Trial Results. N Engl J Med. 2021;384(6):497-511.  [PMID:33264556]

    Comment: The WHO Solidarity Trial was a multicenter, open-label, randomized trial that included adult patients who were hospitalized with a diagnosis of COVID-19. Patients were randomized to five study groups: standard-of-care, remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a. For hydroxychloroquine, the regimen used was 800 mg at hour 0 and 6, followed by 400 mg twice daily starting at hour 12 for 10 days. The primary endpoint was the rate of in-hospital mortality, which the authors did not find a significant difference between the standard-of-care and hydroxychloroquine groups (9.27% vs. 10.98%, respectively; rate ratio 1.19; 95% Cl 0.89-1.59, p=0.23). Furthermore, hydroxychloroquine was not found to reduce the initiation of ventilation.

  8. RECOVERY Collaborative Group, Horby P, Mafham M, et al. Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19. N Engl J Med. 2020;383(21):2030-2040.  [PMID:33031652]

    Comment: The RECOVERY trial was a multicenter, open-label, randomized trial that included adult patients hospitalized with COVID-19. Patients were randomized to either standard-of-care or hydroxychloroquine at a dose of 800 mg at hours 0 and 6, followed by 400 mg twice daily starting at hour 12 for 9 days or until discharge, whichever occurred earlier. The primary endpoint was all-cause mortality within 28 days after randomization, which the authors did not find a significant difference between the standard-of-care and hydroxychloroquine groups (25.0% vs. 27.0%, respectively; rate ratio 1.09; 95% Cl 0.97-1.23, p=0.15). However, the hydroxychloroquine group had a longer duration of hospitalization and a lower probability of being discharged within 28 days compared to the standard-of-care group.

  9. Chu CS, Phyo AP, Lwin KM, et al. Comparison of the Cumulative Efficacy and Safety of Chloroquine, Artesunate, and Chloroquine-Primaquine in Plasmodium vivax Malaria. Clin Infect Dis. 2018;67(10):1543-1549.  [PMID:29889239]

    Comment: In this study of 644 patients with uncomplicated P. vivax malaria, artesunate cleared parasitemia significantly faster than chloroquine. Recurrence rates at day 28 were lowest with chloroquine-primaquine (0.5%; p < 0 .001), compared to chloroquine (8%) or artesunate (50%). Primaquine radical cure reduced the total recurrences by 92.4%.
    Rating: Important

  10. Chatre C, Roubille F, Vernhet H, et al. Cardiac Complications Attributed to Chloroquine and Hydroxychloroquine: A Systematic Review of the Literature. Drug Saf. 2018;41(10):919-931.  [PMID:29858838]

    Comment: A systematic review (n=127 patients) investigated cardiac complications attributed to chloroquine and hydroxychloroquine. 58.3% of patients received chloroquine, and 39.4% received hydroxychloroquine with a median duration of treatment of 7 years (min 3 days –max of 35 years). Conduction disorders were the most common, followed by heart failure, ventricular hypertrophy, hypokinesia, heart failure, pulmonary arterial hypertension and valvular dysfunction. Of 78 patients reported to have been withdrawn from treatment, 44.9% recovered normal heart function, 12.9% had irreversible damage, and 30.8% died.
    Rating: Important

  11. Roques P, Thiberville SD, Dupuis-Maguiraga L, et al. Paradoxical Effect of Chloroquine Treatment in Enhancing Chikungunya Virus Infection. Viruses. 2018;10(5).  [PMID:29772762]

    Comment: In this study, the efficacy of chloroquine was evaluated against the Chikungunya virus as a prophylactic agent in the non-human primate model and curative agent in a human cohort during an outbreak. In the animal model, there was a higher viremia and slower viral clearance (p < 0.003) with the administration of chloroquine, which correlated with type I IFN response and severe lymphopenia. Treatment also led to a delay in both Chikungunya virus-specific cellular and IgM responses. In humans, chloroquine treatment did not impact viremia or clinical parameters during the acute stage of the disease (days 1-14) but decreased Eotaxine, IL-6, and MCP-1 overtime levels (days 1-16).
    Rating: Important

  12. Mohammad S, Clowse MEB, Eudy AM, et al. Examination of Hydroxychloroquine Use and Hemolytic Anemia in G6PDH-Deficient Patients. Arthritis Care Res (Hoboken). 2018;70(3):481-485.  [PMID:28556555]

    Comment: A retrospective review of 275 patients who had G6PD levels measured and were on hydroxychloroquine, only 11 patients (4%) were G6PD deficient (all African American). Two patients developed hemolysis that occurred while they were not taking hydroxychloroquine. No hemolysis was reported in more than 700 months of hydroxychloroquine.

  13. Marmor MF, Kellner U, Lai TY, et al. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy (2016 Revision). Ophthalmology. 2016;123(6):1386-94.  [PMID:26992838]

    Comment: 2016 American Academy of Ophthalmology recommends screening for chloroquine and hydroxychloroquine-related retinopathy: examination before therapy initiation to rule out preexisting maculopathy and annual screening after 5 years for patients on acceptable doses and without significant risk factors.

  14. Dowall SD, Bosworth A, Watson R, et al. Chloroquine inhibited Ebola virus replication in vitro but failed to protect against infection and disease in the in vivo guinea pig model. J Gen Virol. 2015;96(12):3484-3492.  [PMID:26459826]

    Comment: This study shows that chloroquine was not effective in protecting against Ebola virus infection and diseases in guinea pigs despite in vitro inhibition of Ebola virus replication.

  15. Price RN, von Seidlein L, Valecha N, et al. Global extent of chloroquine-resistant Plasmodium vivax: a systematic review and meta-analysis. Lancet Infect Dis. 2014;14(10):982-91.  [PMID:25213732]

    Comment: Study methods and design confound in vitro determination; however, in available studies, 100% clearance documents in humans receiving chloroquine.

  16. Paton NI, Lee L, Xu Y, et al. Chloroquine for influenza prevention: a randomised, double-blind, placebo controlled trial. Lancet Infect Dis. 2011;11(9):677-83.  [PMID:21550310]

    Comment: In this randomized, double-blind, placebo-controlled trial (N=1496), conducted in Singapore, chloroquine (500 mg daily for 1 week, then once per week for 12 weeks) was compared to placebo in preventing influenza. Chloroquine was ineffective in preventing laboratory-confirmed influenza infection (4% vs. 5%, p=0.261). 45% of patients receiving chloroquine experienced adverse events, most commonly headache, dizziness, nausea, diarrhea and blurred vision.
    Rating: Important

  17. Tricou V, Minh NN, Van TP, et al. A randomized controlled trial of chloroquine for the treatment of dengue in Vietnamese adults. PLoS Negl Trop Dis. 2010;4(8):e785.  [PMID:20706626]

    Comment: In this randomized, double-blind, placebo-controlled trial (n=307), a 3-day chloroquine course was ineffective in reducing the duration of Dengue virus viremia and NS1 antigenemia. There was a trend towards a lower incidence of dengue hemorrhagic fever in patients receiving chloroquine compared to placebo. However, use of chloroquine was associated with a higher rate of adverse events.

  18. Laufer MK, Thesing PC, Eddington ND, et al. Return of chloroquine antimalarial efficacy in Malawi. N Engl J Med. 2006;355(19):1959-66.  [PMID:17093247]

    Comment: The study documents the return of efficacy of the drug when not used after a hiatus of 12 years.

  19. Boulos A, Rolain JM, Raoult D. Antibiotic susceptibility of Tropheryma whipplei in MRC5 cells. Antimicrob Agents Chemother. 2004;48(3):747-52.  [PMID:14982759]

    Comment: We report here the first extensive study on the susceptibilities of three reference strains of Tropheryma whipplei to an antibiotic in cell culture using a real-time PCR assay as previously described. A combination of doxycycline and hydroxychloroquine was bactericidal in vitro.

  20. Raoult D, Drancourt M, Vestris G. Bactericidal effect of doxycycline associated with lysosomotropic agents on Coxiella burnetii in P388D1 cells. Antimicrob Agents Chemother. 1990;34(8):1512-4.  [PMID:2221859]

    Comment: When used as monotherapy, doxycycline is bacteriostatic against C. burnetii in P388D1 cells due to the acidic conditions of the phagolysosomes in which C. burnetii is located. However, when chloroquine is added, it leads to the alkalization of C. burnetii-containing lysosomes, which sterilizes the infection.

  21. Titus EO. Recent developments in the understanding of the pharmacokinetics and mechanism of action of chloroquine. Ther Drug Monit. 1989;11(4):369-79.  [PMID:2662478]

    Comment: Review paper summarizing studies related to the pharmacokinetics of chloroquine (published prior to 1989), dosing and mechanism of action in the treatment of malaria and rheumatoid arthritis.

  22. Pappaioanou M, Fishbein DB, Dreesen DW, et al. Antibody response to preexposure human diploid-cell rabies vaccine given concurrently with chloroquine. N Engl J Med. 1986;314(5):280-4.  [PMID:3510393]

    Comment: This randomized trial demonstrates that co-administration of weekly chloroquine beginning 9 days before the first dose of rabies vaccine administration was negatively associated with log antibody titers.

  23. CDC - Appendix A: Malaria in the United States: Treatment Tables. https://www.cdc.gov/malaria/hcp/clinical-guidance/malaria-treatment-tables.html. September 24, 2024.

    Comment: CDC guidelines recommend using chloroquine to treat uncomplicated malaria due to chloroquine susceptible strains of P. vivax, P. ovale, P. malariae, or P. kwnowlesi.



  24. Chloroquine Phosphate [package insert]. Eatontown, NJ: West-ward Pharmaceutical Corp. 2009.

    Comment:
    Since generic the package insert is rarely updated.


Last updated: September 26, 2024