Chloroquine
lINDICATIONS AND DOSE
Prophylaxis of malaria
▶INITIALLY BY MOUTH USING SYRUP
▶Child 4–5 weeks (body-weight up to 4.5 kg): 25 mg once
weekly, started 1 week before entering endemic area
and continued for 4 weeks after leaving
▶Child 6 weeks–5 months (body-weight 4.5–7 kg): 50 mg
once weekly, started 1 week before entering endemic
area and continued for 4 weeks after leaving
▶Child 6–11 months (body-weight 8–10 kg): 75 mg once
weekly, started 1 week before entering endemic area
and continued for 4 weeks after leaving
▶Child 1–2 years (body-weight 11–14 kg): 100 mg once
weekly, started 1 week before entering endemic area
and continued for 4 weeks after leaving
▶Child 3–4 years (body-weight 15–16.4 kg): 125 mg once
weekly, started 1 week before entering endemic area
and continued for 4 weeks after leaving
▶Child 5–7 years (body-weight 16.5–24 kg): 150 mg once
weekly, alternatively (by mouth using tablets) 155 mg
once weekly, started 1 week before entering endemic
area and continued for 4 weeks after leaving
▶Child 8–13 years (body-weight 25–44 kg): 225 mg once
weekly, alternatively (by mouth using tablets) 232. 5 mg
once weekly, started 1 week before entering endemic
area and continued for 4 weeks after leaving
▶INITIALLY BY MOUTH USING TABLETS
▶Child 14–17 years (body-weight 45 kg and above): 310 mg
once weekly, alternatively (by mouth using syrup)
300 mg once weekly, started 1 week before entering
endemic area and continued for 4 weeks after leaving
Treatment of non-falciparum malaria
▶BY MOUTH
▶Child:Initially 10 mg/kg (max. per dose 620 mg), then
5 mg/kg after 6 – 8 hours (max. per dose 310 mg), then
5 mg/kg daily (max. per dose 310 mg) for 2 days
P. vivaxorP. ovaleinfection during pregnancy while
radical cure is postponed
▶BY MOUTH
▶Child: 10 mg/kg once weekly (max. per dose 310 mg)
DOSE EQUIVALENCE AND CONVERSION
▶Doses expressed as chloroquine base.
▶Each tablet contains 155 mg of chloroquine base
(equivalent to 250 mg of chloroquine phosphate).
▶Syrup contains 50 mg/ 5 mL of chloroquine base
(equivalent to 80 mg/ 5 mL of chloroquine phosphate).lUNLICENSED USEChloroquine doses for the treatment and
prophylaxis of malaria in BNF publications may differ from
those in product literature.
lCAUTIONSAcute porphyrias p. 603 .diabetes (may lower
blood glucose).G6PD deficiency.long-term therapy
(regular ophthalmic examination recommended by
manufacturers).may aggravate myasthenia gravis.may
exacerbate psoriasis.neurological disorders, especially
epilepsy (avoid for prophylaxis of malaria if history of
epilepsy).severe gastro-intestinal disorders
lINTERACTIONS→Appendix 1 : antimalarials
lSIDE-EFFECTS
▶Rare or very rareCardiomyopathy.hallucination.
hepatitis
▶Frequency not knownAbdominal pain.agranulocytosis.
alopecia.anxiety.atrioventricular block.bone marrow
disorders.confusion.corneal deposits.depression.
diarrhoea.eye disorders.gastrointestinal disorder.
headache.hearing impairment.hypoglycaemia.
hypotension.insomnia.interstitial lung disease.
movement disorders.myopathy.nausea.neuromyopathy
.neutropenia.personality change.photosensitivity
reaction.psychotic disorder.QT interval prolongation.
seizure.severe cutaneous adverse reactions (SCARs).skin
reactions.thrombocytopenia.tongue protrusion.vision
disorders.vomiting
SIDE-EFFECTS, FURTHER INFORMATIONSide-effects which
occur at doses used in the prophylaxis or treatment of
malaria are generally not serious.
Overdose Chloroquine is very toxic in overdosage;
overdosage is extremely hazardous and difficult to treat.
Urgent advice from the National Poisons Information
Service is essential. Life-threatening features include
arrhythmias (which can have a very rapid onset) and
convulsions (which can be intractable).
lPREGNANCYBenefit of use in prophylaxis and treatment
in malaria outweighs risk. For rheumatoid disease, it is not
necessary to withdraw an antimalarial drug during
pregnancy if the disease is well controlled.
lBREAST FEEDINGPresent in breast milk and breast-
feeding should be avoided when used to treat rheumatic
disease. Amount in milk probably too small to be harmful
when used for malaria.
lHEPATIC IMPAIRMENTUse with caution in moderate to
severe impairment.
lRENAL IMPAIRMENTManufacturers advise caution.
Dose adjustmentsOnly partially excreted by the kidneys
and reduction of the dose is not required for prophylaxis of
malaria except in severe impairment.
For rheumatoid arthritis and lupus erythematosus,
reduce dose.
lMONITORING REQUIREMENTSOphthalmic examination
with long-term therapy.
lPATIENT AND CARER ADVICEWarn travellers going to
malarious areas aboutimportanceof avoiding mosquito
bites,importanceof taking prophylaxis regularly, and
importanceof immediate visit to doctor if ill within 1 year
andespeciallywithin 3 months of return.
lNATIONAL FUNDING/ACCESS DECISIONS
NHS restrictionsDrugs for malaria prophylaxis are not
prescribable in NHS primary care; health authorities may
investigate circumstances under which antimalarials are
prescribed.
lEXCEPTIONS TO LEGAL CATEGORYCan be sold to the public
provided it is licensed and labelled for the prophylaxis of
malaria.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral solution
Oral solution
CAUTIONARY AND ADVISORY LABELS 5
▶Malarivon(Wallace Manufacturing Chemists Ltd)
Chloroquine phosphate 16 mg per 1 mlMalarivon 80 mg/ 5 ml syrup
| 75 mlP£ 30. 00 DT = £ 30. 00
Tablet
CAUTIONARY AND ADVISORY LABELS 5
▶Avloclor(Alliance Pharmaceuticals Ltd)
Chloroquine phosphate 250 mgAvloclor 250 mg tablets|
20 tabletP£ 8. 59 DT = £ 8. 59Chloroquine with proguanil
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, chloroquine above, proguanil hydrochloride
p. 397.lINDICATIONS AND DOSE
Prophylaxis of malaria
▶BY MOUTH
▶Child:(consult product literature)BNFC 2018 – 2019 Malaria 395
Infection5