Chloroquine

Aka: Chloroquine, Aralen

1. Indications
   1. Malaria Prophylaxis
      1. Areas without Chloroquine resistance
   2. Discoid Lupus (off label)
   3. NOT indicated in COVID-19 outside of clinical trials as of May 2020
      1. Low efficacy in trials to date and risk of serious reactions (including QTc Prolongation)
      2. https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v2
2. Safety
   1. Safe in all trimesters of pregnancy (but Chloroquine does cross the placenta)
   2. Safe for children of all ages
3. Dose: Malaria Prophylaxis
   1. Protocol
      1. Start 1-2 weeks before travel
      2. Continue through 4 weeks after return
   2. Adult: 300 mg base (500 mg salt) PO once weekly
   3. Child: Dose: 5 mg/kg base (8.3 mg/kg salt) up to 300 mg base orally once weekly
4. Dose: Malaria Treatment
   1. Adults
      1. Load: 1000 mg salt (600 mg base) orally at start
      2. Maintenance: 500 mg salt (300 mg base) orally at 6 hours, 24 hours and 48 hours after initial dose
   2. Child
      1. Load: 16.7 mg/kg salt (10 mg/kg base) orally at start
      2. Maintenance: 8.3 mg/kg salt (5 mg/kg base) orally at 6 hours, 24 hours and 48 hours after initial dose
5. Technique
   1. Taking with food decreases gastric irritation
6. Adverse Effects
   1. Cardiovascular
      1. AV Block
      2. QTc Prolongation
         1. Risk of Ventricular Tachycardia including Drug-Induced Torsades de Pointes
   2. Dermatologic
      1. Hair, skin and Nail Discoloration
      2. Erythema Multiforme
   3. Endocrine
      1. Hypoglycemia
   4. Ear
      1. Tinnitus
      2. Hearing Loss
   5. Eye
      1. Blurred Vision
      2. Corneal disorders
      3. Retinopathy (more common than with Hydroxychloroquine)
   6. Gastrointestinal
      1. Nausea and Vomiting
      2. Diarrhea
      3. Abdominal Pain
   7. Hematologic
      1. Agranulocytosis
      2. Neutropenia
      3. Pancytopenia
      4. Thrombocytopenia
   8. Neurologic
      1. Confusion or Delirium
      2. Hallucination
      3. Psychosis
      4. Insomnia
      5. Extrapyramidal Side Effects
      6. Depressed mood and Suicidality
7. Efficacy
   1. Most world regions exhibit high Chloroquine resistance in Plasmodium Falciparum
   2. Limit use to only nonsevere infections from non-Chloroquine resistance regions
8. References
   1. (2020) LexiComp, Chloroquine, accessed 5/6/2020
   2. Shahbodaghi (2022) Am Fam Physician 106(3): 270-8 [PubMed]