Medicine Information

HCQ

Tablet200 mgAntimalarial, Disease-Modifying Antirheumatic Drug (DMARD)ATC: P01BA02

Generic Name

Hydroxychloroquine Sulfate 200 mg tablet

Manufacturer

Various generic manufacturers

Country

Global

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Price Details

Current market pricing information

Variant	Unit Price	Strip Price
hcq 200 mg tablet	৳ 15.00	৳ 150.00

Description

Overview of the medicine

Hydroxychloroquine (HCQ) is an antimalarial and anti-inflammatory drug used to prevent and treat malaria, and manage autoimmune diseases like rheumatoid arthritis and lupus erythematosus. It belongs to the class of 4-aminoquinoline derivatives.

Uses & Indications

Treatment and prophylaxis of malaria

Rheumatoid arthritis

Systemic lupus erythematosus

Discoid lupus erythematosus

Dosage

Adults

Malaria prophylaxis: 400 mg once weekly (starting 1-2 weeks before exposure). Acute malaria: Initial 800 mg, then 400 mg after 6-8 hours, then 400 mg daily for 2 days. Rheumatoid arthritis/Lupus: Initial 400-600 mg daily, then maintenance 200-400 mg daily. Max 6.5 mg/kg body weight/day.

Elderly

No specific dosage adjustment, but monitor for renal/hepatic impairment and pre-existing conditions.

Renal_impairment

Dosage adjustment required based on creatinine clearance. For CrCl < 30 mL/min, dose reduction or increased dosing interval may be needed.

How to Take

Oral, with food or milk to minimize gastrointestinal upset.

Mechanism of Action

HCQ's antimalarial action involves concentrating in parasite food vacuoles, interfering with heme detoxification. Its anti-inflammatory and immunomodulatory effects in autoimmune diseases are thought to be due to interference with lysosomal activity, inhibition of antigen presentation, and suppression of cytokine production (e.g., TNF-alpha, IL-1, IL-6). It also raises lysosomal pH in antigen-presenting cells.

Pharmacokinetics

Onset

Antimalarial effect: hours to days. Autoimmune diseases: weeks to months (e.g., 6-12 weeks for rheumatoid arthritis).

Excretion

Primarily renal (about 50% unchanged drug in urine); some biliary excretion.

Half life

Elimination half-life is highly variable, ranging from approximately 32 days to 50 days or longer.

Absorption

Rapidly absorbed from the gastrointestinal tract; bioavailability is about 74%.

Metabolism

Primarily hepatic metabolism by CYP2D6 to active metabolites desethylchloroquine and bidesethylchloroquine.

Side Effects

Contraindications

Hypersensitivity to 4-aminoquinoline compounds
Pre-existing maculopathy
Long-term use in children (for malaria prophylaxis)

Drug Interactions

Digoxin

Increased plasma levels of digoxin.

Mefloquine

Increased risk of seizures.

Cyclosporine

Increased plasma levels of cyclosporine.

Antacids/Kaolin

May reduce absorption of HCQ.

Insulin/Oral Hypoglycemics

May enhance hypoglycemic effects.

Storage

Store at controlled room temperature (20°C to 25°C), away from moisture and light. Keep in original packaging.

Overdose

Symptoms include headache, drowsiness, visual disturbances, cardiovascular collapse, and seizures. Management involves gastric lavage, activated charcoal, and symptomatic supportive care.

Pregnancy & Lactation

Pregnancy Category C (risk cannot be ruled out). Use if benefits outweigh risks. Considered compatible with breastfeeding at usual doses for malaria. For autoimmune conditions, consult a doctor.

Frequently Asked Questions

Common questions about this medicine

Pack Sizes

10 tablets/strip30 tablets/bottle

Shelf Life

2-3 years (refer to manufacturer's label)

Availability

Pharmacies, Hospitals

Approval Status

Approved by FDA/DGDA for specific indications

Patent Status

Generic available

WHO Essential Medicine

Yes

Clinical Trials

Extensive clinical trials for lupus, rheumatoid arthritis, and malaria. Also explored in COVID-19 trials (found ineffective).

Lab Monitoring

Baseline and annual ophthalmologic examination (including visual acuity, fundoscopy, visual fields, OCT)
Complete blood count (CBC)
Liver function tests
Renal function tests

Doctor Notes

Emphasize the importance of baseline and annual ophthalmic screenings.
Educate patients on potential retinopathy symptoms.
Monitor for cardiotoxicity in patients with pre-existing cardiac conditions.
Regularly assess for drug interactions, especially with narrow therapeutic index drugs.

Patient Guidelines

Take with food or milk.
Do not stop suddenly without consulting a doctor.
Report any vision changes immediately.
Regular eye exams are crucial for long-term use.
Keep out of reach of children.

Missed Dose Advice

If a dose is missed, take it as soon as remembered unless it's almost time for the next dose. Do not double the dose.

Driving Precautions

May cause visual disturbances, dizziness, or blurred vision. Patients should be cautious when driving or operating machinery until they know how the drug affects them.