Formulary
Chloroquine: Indications, Dosing, Side Effects and Interactions
Chloroquine clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 6 min read
Chloroquine: Indications, Dosing, Side Effects and Interactions
Chloroquine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Active rheumatoid arthritis (administered on expert advice),Systemic and discoid lupus erythematosus (administered on expert advice)**
- **Adult** (By Mouth Using Tablets): 155 mg daily; maximum 2.5 mg/kg per day.
**Prophylaxis of malaria**
- **Child** (By Mouth Using Syrup): (body-weight 45 kg and above) 300 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Adult** (By Mouth Using Syrup): (body-weight 45 kg and above) 300 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child** (By Mouth Using Tablets): (body-weight 45 kg and above) 310 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Adult** (By Mouth Using Tablets): (body-weight 45 kg and above) 310 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
**Treatment of non-falciparum malaria**
- **Child** (By Mouth): 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.
- **Adult** (By Mouth): Initially 620 mg, then 310 mg after 6-8 hours, then 310 mg daily for 2 days, approximate total cumulative dose of 25 mg/kg of base.
**P. vivaxorP. ovaleinfection during pregnancy while radical cure is postponed**
- **Adult** (By Mouth): P. vivax or P. ovale infection during pregnancy while radical cure is postponed 310 mg once weekly.
**Prophylaxis of malaria for chloroquine**
- **Child (body-weight up to 4.5 kg)** (By mouth using syrup): 25 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 4.5-7 kg)** (By mouth using syrup): 50 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 8-10 kg)** (By mouth using syrup): 75 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 11-14 kg)** (By mouth using syrup): 100 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 15-16.4 kg)** (By mouth using syrup): 125 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 16.5-24 kg)** (By mouth using syrup): 150 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 25-44 kg)** (By mouth using syrup): 225 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 45 kg and above)** (By mouth using syrup): 300 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight up to 6 kg)** (By mouth using tablets): 38.75 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 6-9 kg)** (By mouth using tablets): 77.5 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 10-15 kg)** (By mouth using tablets): 116.25 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 16-24 kg)** (By mouth using tablets): 155 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 25-44 kg)** (By mouth using tablets): 232.5 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
- **Child (body-weight 45 kg and above)** (By mouth using tablets): 310 mg once weekly, started 1 week before entering endemic area and continued for 4 weeks after leaving.
**Treatment of non-falciparum malaria for chloroquine**
- **Child** (By mouth): 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. vivax or P. ovale infection during pregnancy while radical cure is postponed for chloroquine**
- **Child** (By mouth): 10 mg/kg once weekly (max. per dose 310 mg).
Cautions
Acute porphyrias ; diabetes (may lower blood glucose); G6PD deficiency; long-term therapy (risk of retinopathy and cardiomyopathy); may aggravate myasthenia gravis; may exacerbate psoriasis; neurological disorders, especially epilepsy (may lower seizure threshold)-avoid for prophylaxis of malaria if history of epilepsy; severe gastro-intestinal disorders
Side effects
Rare or very rare Cardiomyopathy; hallucination; hepatitis Frequency not known Abdominal pain; agranulocytosis; alopecia; anxiety; atrioventricular block; behaviour abnormal; bone marrow disorders; concentration impaired; confusion; corneal deposits; delusions; depression; diarrhoea; eye disorders; gastrointestinal disorder; headache; hearing impairment; hypoglycaemia; hypotension; interstitial lung disease; mania; movement disorders; myopathy; nausea; neuromyopathy; neutropenia; photosensitivity reaction; psychiatric disorder; psychosis; QT interval prolongation; seizure; severe cutaneous adverse reactions (SCARs); skin reactions; sleep disorders; suicidal behaviour; thrombocytopenia; tinnitus; tongue protrusion; vision disorders; vomiting Side-effects, further information Side-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).
Interactions
**Other interactions (23):**
- Aldurazyme should not be administered simultaneously with chloroquine or procaine due to a potential risk of interference with the intracellular uptake of laronidase.
- Anti-malaria agents Mefloquine and chloroquine increase valproic acid metabolism and may lower the seizure threshold; therefore epileptic seizures may occur in cases of combined therapy.
- This product may interfere with the absorption of tetracyclines, chloroquine, penicillamine, phenothiazines and quinolone antibacterials, when these are given concomitantly.
- Chloroquine Hydroxychloroquine sulfate may also be subject to several of the known interactions of chloroquine even though specific reports have not appeared.
- Antacids As with chloroquine, antacids may reduce absorption of hydroxychloroquine so it is advised that a 4 hour interval be observed between Hydroxychloroquine sulfate and antacid dosaging.
- Praziquantil In a single-dose interaction study, chloroquine has been reported to reduce the bioavailability of praziquantel.
Pregnancy
P. vivax or P. ovale infection during pregnancy while radical cure is postponed for chloroquine By mouth Adult 310 mg once weekly.
Breast feeding
When used for Rheumatic disease in adults: May be used with caution during breast-feeding (very limited information available). Present in milk in small amounts-very long plasma half-life increases risk of accumulation in the infant. Monitor infant for irritability, insomnia, vomiting, diarrhoea, poor feeding, adequate weight gain, and ocular and hearing effects. Avoid in infants with G6PD deficiency, hyperbilirubinaemia, or jaundice (risk of haemolytic anaemia and kernicterus). E When used for Prophylaxis of malaria: Present in milk but amount probably too small to be harmful. M When used for Treatment of malaria: advises safe for use.
Hepatic impairment
Manufacturer advises caution, particularly in cirrhosis.
Renal impairment
Manufacturers advise caution. Dose adjustments Only 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.
Medicinal forms
Solution,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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