Delagil

Indications

• Treatment of malaria caused by Plasmodium vivax, P. ovale and P. malariae, and by P. falciparum only where it is still sensitive to chloroquine. For vivax and ovale malaria, Primaquine is usually added to prevent relapse.
• Prevention of malaria for travellers to areas where the parasite is still sensitive, as advised by a doctor.
• Less often: amoebic liver abscess, and rheumatoid arthritis or lupus under specialist care.

How It Works

Chloroquine builds up inside the malaria parasite while it lives in red blood cells and stops it from safely breaking down the blood it feeds on, so the parasite is poisoned and dies. It also calms parts of the immune system, which is why it can help some joint and skin diseases.

Dosage and Administration

The dose is worked out from body weight and is counted as chloroquine "base" (250 mg chloroquine phosphate contains about 155 mg base), so take it exactly as prescribed. Malaria treatment is usually a 3-day course with a larger dose on the first two days and a smaller dose on the third. Take with or after food to reduce stomach upset. Syrup doses for children are based on weight and must be measured carefully. The injection is given by a doctor or nurse in hospital.

Interactions

• Antacids and Kaolin reduce absorption: take them at least 4 hours apart.
• Medicines that affect heart rhythm, such as Amiodarone, Moxifloxacin, Azithromycin, some antipsychotics and Mefloquine: higher risk of heart rhythm problems; Mefloquine also raises the risk of fits.
• Ciclosporin and Digoxin levels can rise.
• Cimetidine increases chloroquine levels.
• Ampicillin and Praziquantel levels can fall; keep Ampicillin at least 2 hours apart.
• Insulin and diabetes tablets: blood sugar can drop.
• It may weaken the response to the intradermal rabies vaccine.

Contraindications

Allergy to chloroquine or Hydroxychloroquine. Existing damage to the retina or changes in vision from earlier use. Long-term use is avoided in people with retinal disease.

Side Effects

Common: nausea, vomiting, stomach upset, diarrhoea, headache, loss of appetite and itching (very common in people with darker skin and not dangerous). Blurred vision may occur and usually passes. Long-term use can damage the retina, so regular eye checks are needed.

Get urgent medical help for any change in vision, fainting, a fast or irregular heartbeat, fits, muscle weakness, hearing loss or ringing in the ears, signs of low blood sugar (sweating, shaking, confusion), a blistering or peeling skin rash, or swelling of the face, lips or throat.

Pregnancy and Lactation

Malaria is very dangerous in pregnancy. Chloroquine is considered safe to treat or prevent malaria in pregnancy at the normal doses chosen by the doctor. Small amounts pass into breast milk; it is generally acceptable while breastfeeding but does not protect the baby from malaria.

Precautions and Warnings

Keep it well out of the reach of children: even a few tablets can kill a small child. Tell the doctor about epilepsy, psoriasis, porphyria, G6PD deficiency, myasthenia gravis, heart rhythm problems, diabetes, or liver or kidney disease. People on long-term treatment need eye checks. In areas where falciparum malaria is resistant, chloroquine alone will not work, so follow the doctor's treatment choice.

Overdose

Chloroquine overdose is a medical emergency and can be fatal within hours, especially in children. Symptoms include drowsiness, vision problems, a very low blood pressure, an irregular heartbeat, fits and breathing difficulty. Go to hospital immediately, even if the person seems well.

Therapeutic Class

Antimalarial (4-aminoquinoline).

Storage

Store below 30°C in a dry place, away from light and well out of the reach of children. Do not freeze the syrup.