Usual Adult Dose for Malaria Prophylaxis

500 mg salt (300 mg base) orally once a week

Comments:

• This drug should be administered on the same day of each week.
• If possible, suppressive therapy should start 2 weeks prior to exposure; if unable to start 2 weeks before exposure, an initial loading dose of 1 g salt (600 mg base) may be taken orally in 2 divided doses, 6 hours apart.
• Suppressive therapy should continue for 8 weeks after leaving the endemic area.

Use: For the prophylaxis of malaria in geographic areas where resistance to this drug is not present (i.e., for prophylaxis against chloroquine-sensitive Plasmodium species)

US CDC Recommendations: 300 mg base (500 mg salt) orally once a week

Comments:

• For prophylaxis only in areas with chloroquine-sensitive malaria
• Prophylaxis should start 1 to 2 weeks before travel to malarious areas; should continue weekly (same day each week) while in malarious areas and for 4 weeks after leaving such areas
• If malaria develops while using this drug for chemoprophylaxis, it should not be used as part of the treatment regimen.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Malaria

Less than 60 kg:

• First dose: 16.7 mg/kg salt (10 mg/kg base) orally
• Second dose (6 hours after first dose): 8.3 mg/kg salt (5 mg/kg base) orally
• Third dose (24 hours after first dose): 8.3 mg/kg salt (5 mg/kg base) orally
• Fourth dose (36 hours after first dose): 8.3 mg/kg salt (5 mg/kg base) orally

Total dose: 41.7 mg/kg salt (25 mg/kg base) in 3 days

At least 60 kg: 1 g salt (600 mg base) orally as an initial dose, followed by 500 mg salt (300 mg base) orally after 6 to 8 hours, then 500 mg salt (300 mg base) orally once a day on the next 2 consecutive days
Total dose: 2.5 g salt (1.5 g base) in 3 days

Comments:

• Concomitant therapy with an 8-aminoquinoline compound is necessary for treatment of the hypnozoite liver stage forms of Plasmodium vivax and P ovale.

Use: For the treatment of uncomplicated malaria due to susceptible strains of P falciparum, P malariae, P ovale, and P vivax

US CDC Recommendations: 600 mg base (1 g salt) orally at once, followed by 300 mg base (500 mg salt) orally at 6, 24, and 48 hours
Total dose: 1.5 g base (2.5 g salt)

Comments:

• Recommended for uncomplicated malaria (P falciparum or species not identified) in regions with chloroquine sensitivity
• Recommended for uncomplicated malaria (P malariae, P knowlesi, P vivax [unless chloroquine-resistant P vivax suspected], or P ovale) in all regions; if treating P vivax or P ovale infections, concomitant treatment with primaquine or tafenoquine (after quantitative testing to rule out glucose-6-phosphate dehydrogenase [G6PD] deficiency) is recommended.
• Recommended for uncomplicated malaria treatment for pregnant women in regions with chloroquine sensitivity
• Pregnant patients with P vivax and P ovale infections should receive chloroquine prophylaxis (300 mg base orally once a week) during pregnancy; after delivery, patients with normal G6PD activity should be treated with primaquine or tafenoquine or continue chloroquine prophylaxis for 1 year (total).
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Amebiasis

1 g salt (600 mg base) orally once a day for 2 days, followed by 500 mg salt (300 mg base) orally once a day for at least 2 to 3 weeks

Comments:

• Treatment is usually combined with an effective intestinal amebicide.

Use: For the treatment of extraintestinal amebiasis

Usual Adult Dose for Sarcoidosis

Study (n=43)
Intrathoracic and cutaneous: 250 mg twice a day for 4 to 17 months; a treatment course should be limited to 6 months to minimize risk of ocular damage

Study (n=23)
Pulmonary: 750 mg per day for 6 months, then tapered every 2 months to 250 mg per day

Study (n=37)
Nervous system (neurosarcoidosis): 250 mg twice a day for 6 to 18 months

Usual Pediatric Dose for Malaria Prophylaxis

Infants and children: 5 mg/kg base (8.3 mg/kg salt) orally once a week

Comments:

• This drug should be administered on the same day of each week.
• Pediatric dose should not exceed the adult dose regardless of weight.
• If possible, suppressive therapy should start 2 weeks prior to exposure; if unable to start 2 weeks before exposure, an initial loading dose of 10 mg/kg base (16.7 mg/kg salt) may be taken orally in 2 divided doses, 6 hours apart.
• Suppressive therapy should continue for 8 weeks after leaving the endemic area.

Use: For the prophylaxis of malaria in geographic areas where resistance to this drug is not present (i.e., for prophylaxis against chloroquine-sensitive Plasmodium species)

US CDC Recommendations: 5 mg/kg base (8.3 mg/kg salt) orally once a week
Maximum dose: 300 mg base (500 mg salt)/dose

Comments:

• For prophylaxis only in areas with chloroquine-sensitive malaria
• Prophylaxis should start 1 to 2 weeks before travel to malarious areas; should continue weekly (same day each week) while in malarious areas and for 4 weeks after leaving such areas
• If malaria develops while using this drug for chemoprophylaxis, it should not be used as part of the treatment regimen.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Malaria

Infants and children:

• First dose: 10 mg/kg base (16.7 mg/kg salt) orally
• Second dose (6 hours after first dose): 5 mg/kg base (8.3 mg/kg salt) orally
• Third dose (24 hours after first dose): 5 mg/kg base (8.3 mg/kg salt) orally
• Fourth dose (36 hours after first dose): 5 mg/kg base (8.3 mg/kg salt) orally

Total dose: 25 mg/kg base (41.7 mg/kg salt) in 3 days

Maximum Dose:

• First dose: 600 mg base (1 g salt)/dose
• Second, third, and fourth dose: 300 mg base (500 mg salt)/dose
• Total dose: 1.5 g base (2.5 g salt) in 3 days

Comments:

• Concomitant therapy with an 8-aminoquinoline compound is necessary for treatment of the hypnozoite liver stage forms of P vivax and P ovale.

Use: For the treatment of uncomplicated malaria due to susceptible strains of P falciparum, P malariae, P ovale, and P vivax

US CDC Recommendations: 10 mg/kg base orally at once, followed by 5 mg/kg base orally at 6, 24, and 48 hours
Total dose: 25 mg/kg base

Comments:

• Pediatric dose should never exceed adult dose.
• Recommended for uncomplicated malaria (P falciparum or species not identified) in regions with chloroquine sensitivity
• Recommended for uncomplicated malaria (P malariae, P knowlesi, P vivax [unless chloroquine-resistant P vivax suspected], or P ovale) in all regions; if treating P vivax or P ovale infections, concomitant treatment with primaquine or, in children 16 years or older, tafenoquine (after quantitative testing to rule out G6PD deficiency) is recommended.
• Current guidelines should be consulted for additional information.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Liver disease, alcoholism, or with concomitant hepatotoxic agents: Caution recommended.

Precautions

CONTRAINDICATIONS:

• Indications other than acute malaria: Presence of retinal or visual field changes of any etiology
• Known hypersensitivity to 4-aminoquinoline compounds

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Storage requirements:

• Protect from light and moisture.

General:

• The dose of this drug is often expressed or calculated as the base; each 500 mg tablet of chloroquine phosphate is equivalent to 300 mg chloroquine base.
• The pediatric dose should never exceed the adult dose.
• This drug does not prevent relapses in patients with vivax or ovale malaria; it is not effective against exoerythrocytic forms of the parasites.
• Limitations of Use in Malaria:
• This drug should not be used for the treatment of complicated malaria (high-grade parasitemia and/or complications [e.g., cerebral malaria, acute renal failure]); coadministration with an 8-aminoquinoline drug is required for treatment of the hypnozoite liver stage forms of P vivax and P ovale.
• This drug should not be used for malaria prophylaxis in areas where chloroquine resistance occurs; resistance to this drug is widespread in P falciparum and is reported in P vivax.

Monitoring:

• Cardiovascular: For signs/symptoms of cardiomyopathy
• Hematologic: Complete blood cell counts (periodically, if prolonged therapy)
• Musculoskeletal: For signs of muscular weakness, including knee and ankle reflexes (if prolonged therapy)
• Ocular: Ophthalmological examination, including best corrected distance visual acuity, automated threshold visual field of the central 10 or 24 degrees (the manufacturer product information should be consulted), and spectral domain optical coherence tomography (at baseline [within first year of starting therapy] then annually with significant risk factors or deferred until 5 years of therapy without significant risk factors)
• Renal: Renal function in elderly patients

Patient advice:

• Watch for clinical signs/symptoms of hypoglycemia.
• It is very important to keep this drug out of the reach of children.

Frequently asked questions

• An Update: Is hydroxychloroquine effective for COVID-19?