Chloroquine

Should be taken with food.

Presence of retinal or visual field changes of any cause (when used for indications other than acute malaria). Concomitant use with amiodarone.

Patient with congenital or documented acquired QT prolongation and known risk factors for QT interval prolongation (e.g. cardiac disease, history of ventricular arrhythmias, bradycardia [< 50 bpm], uncorrected hypokalaemia and/or hypomagnesaemia, concomitant use with agents that prolong QT interval); pre-existing auditory damage, myasthenia gravis, porphyria, psoriasis, G6PD deficiency, alcoholism; neurological disorders (particularly history of epilepsy), severe gastrointestinal disease. When indicated for prophylaxis of malaria, consider official country guidelines and local information on the prevalence of resistance to anti-malarial agents. Hepatic and renal impairment. Children. Pregnancy and lactation. Patient Counselling This drug may affect visual accommodation which may lead to blurred and/or double vision; if affected, do not drive or operate machinery. Monitoring Parameters Monitor CBC with differential, LFTs, and renal function at baseline and regularly during treatment; blood glucose, muscle strength (particularly proximal muscles) during long-term use; ECG at baseline and as clinically necessary (particularly in patients with an increased risk of QT prolongation). Perform ophthalmologic exam (fundus exam within the 1st year plus visual fields and spectral-domain optical coherence tomography if with maculopathy) at baseline then screen annually starting after 5 years of use (or sooner if major risk factors are present). Assess for signs and symptoms of cardiomyopathy, retinopathy, hearing defects, and psychiatric reactions.

Significant: Retinal toxicity which may cause irreversible retinopathy (high doses and prolonged use); hearing defects, proteinuria (with or without moderate decrease in GFR); skeletal muscle myopathy or neuropathy, resulting in progressive weakness and atrophy of proximal muscle groups; abnormal nerve conduction, acute extrapyramidal disorders, new onset or worsening of myasthenia gravis; exacerbation of porphyria and psoriasis, drug reaction with eosinophilia and systemic symptoms (DRESS); suicidal behaviour, psychiatric disorders; increased risk of haemolytic anaemia (particularly in patients with G6PD deficiency). Rarely, haematologic reactions (e.g. reversible agranulocytosis, neutropenia, aplastic anaemia, pancytopenia, thrombocytopenia); convulsions, diffuse parenchymal lung disease. Ear and labyrinth disorders: Tinnitus, nerve type deafness, hypoacusis. Eye disorders: Blurred vision, diplopia, visual field defects, accommodation disorder, macular degeneration, maculopathy, reversible corneal opacity, pigmented deposits, macular defects of colour vision, optic atrophy, scotomas. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain or cramps. Hepatobiliary disorders: Hepatitis. Immune system disorders: Hypersensitivity and anaphylactic reactions, including angioedema. Investigations: Increased liver enzymes, ECG changes. Metabolism and nutrition disorders: Anorexia. Nervous system disorders: Headache, polyneuropathy. Psychiatric disorders: Insomnia, confusion, anxiety, personality changes, hallucination, depression. Skin and subcutaneous tissue disorders: Pruritus, skin photosensitivity, urticaria, alopecia, bleaching of hair pigment, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme; bluish-black pigmentation of the skin, mucous membrane and nails. Vascular disorders: Hypotension.
Potentially Fatal: Cardiomyopathy leading to cardiac failure (prolonged use at high doses), QT prolongation, torsades de pointes, ventricular arrhythmias; severe hypoglycaemia, including loss of consciousness.

May increase the serum levels of ciclosporin and digoxin. Increased risk of convulsions with mefloquine. May inhibit the actions of antiepileptic drugs. Absorption may be reduced with antacids (e.g. Al, Ca, and Mg salts) and adsorbents (e.g. kaolin). May suppress the antibody response to pre-exposure primary immunisation with intradermal human diploid-cell rabies vaccine. May reduce the serum levels of praziquantel. May diminish the therapeutic effects of neostigmine and pyridostigmine. Cimetidine may inhibit the metabolism of chloroquine leading to increased plasma concentration. May enhance the hypoglycaemic effects of insulin and other antidiabetic drugs. Increased risk of retinal toxicity with tamoxifen. May inhibit the intracellular α-galactosidase activity of agalsidase alfa and agalsidase beta.

Antiamoebics / Antimalarials / Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

P01BA01 - chloroquine ; Belongs to the class of aminoquinoline antimalarials.