Roquin

Indications

Hydroxychloroquine is used to treat rheumatoid arthritis, systemic lupus erythematosus (lupus) and discoid lupus, and some other immune-related skin and joint conditions. It is also used to prevent and treat certain types of malaria, as prescribed.

How It Works

In arthritis and lupus it calms an overactive immune system, reducing inflammation, joint pain and skin rashes. Its effect builds up slowly, so it may take 2 to 3 months to feel the full benefit. In malaria it stops the parasite from growing inside red blood cells.

Dosage and Administration

Rheumatoid arthritis and lupus, adults: usually 200 to 400 mg a day, as one dose or two divided doses, and not more than 5 mg per kg of body weight a day. The doctor may lower the dose once the condition is controlled. Malaria prevention and treatment: as prescribed. Children: dose by weight, as prescribed. Swallow tablets whole with food or a glass of milk.

Interactions

• Antacids and Kaolin: reduce absorption; take at least 4 hours apart.
• Medicines that affect heart rhythm (QT prolongation), such as Amiodarone, Moxifloxacin, Azithromycin, Haloperidol and some antidepressants: increased risk of irregular heartbeat.
• Insulin and diabetes tablets: blood sugar may fall too low; dose changes may be needed.
• Digoxin and Ciclosporin: blood levels may rise.
• Medicines for epilepsy: hydroxychloroquine may lower the seizure threshold.
• Mefloquine and other antimalarials: higher risk of side effects.

Contraindications

• Allergy to hydroxychloroquine or similar medicines (4-aminoquinolines such as Chloroquine).
• Existing damage to the retina (maculopathy) of the eye.
• Long-term use in young children.

Side Effects

Common: nausea, stomach pain, diarrhoea, loss of appetite, headache, skin rash and itching. Less common: dizziness, ringing in the ears, hair thinning, darkening of the skin or nails, mood changes. Get urgent medical help if you notice blurred vision, difficulty reading, seeing halos or missing areas in your vision; a fast, irregular heartbeat, fainting or chest pain; signs of low blood sugar (sweating, shaking, confusion); severe skin reactions with blistering, peeling or mouth sores; muscle weakness; or thoughts of self-harm or severe mood changes.

Pregnancy and Lactation

In lupus and some other conditions, doctors often continue it during pregnancy because stopping can cause the disease to flare. Do not stop or start it on your own; discuss it with your doctor before or as soon as you become pregnant. Small amounts pass into breast milk; it is generally considered compatible with breastfeeding, but ask your doctor.

Precautions and Warnings

Long-term use can damage the retina. Have an eye examination at the start of treatment and regular checks afterwards (usually yearly after 5 years of use, or earlier if you have risk factors). Tell your doctor if you have heart disease or rhythm problems, liver or kidney disease, diabetes, epilepsy, psoriasis, porphyria, G6PD deficiency or a blood disorder. Your doctor may check blood counts and do an ECG. Avoid strong sunlight if your skin is sensitive.

Overdose

Overdose is very dangerous and can quickly cause heart rhythm problems, seizures, breathing difficulty and collapse. Even a few tablets can be fatal to a small child. Seek emergency medical help immediately.

Therapeutic Class

Antimalarial; disease-modifying antirheumatic drug (DMARD).

Storage

Store below 30°C in a dry place, away from light. Keep well out of the reach and sight of children.