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In Test

Zinc 24 Hours Urine Test

Uses: Identifying the cause of abnormal serum zinc concentrations using a 24-hour urine specimen. Useful as an indicator of acute toxicity. May be useful as an indicator of deficiency in conjunction with Zinc, Serum or Plasma

Method: Quantitative Inductively Coupled Plasma-Mass Spectrometry (ICPMS)

Category: Endocrinology

Reference:

Test Number Components Reference Interval
Zinc, Urine 15.0-120.0 µg/dL
Zinc, Urine-per 24h 150.0-1200.0 µg/d
Zinc, Urine-ratio to CRT 110.0-750.0 µg/gCRT
Creatinine, Urine – per 24h
Age Male Female
3-8 years 140-700 mg/d 140-700 mg/d
9-12 years 300-1300 mg/d 300-1300 mg/d
13-17 years 500-2300 mg/d 400-1600 mg/d
18-50 years 1000-2500 mg/d 700-1600 mg/d
51-80 years 800-2100 mg/d 500-1400 mg/d
81 years and older 600-2000 mg/d 400-1300 mg/d

Pre-test Information:

  • Patients should be encouraged to discontinue nutritional supplements, vitamins, minerals, and non-essential over-the-counter medications (upon the advice of their physician)
  • Collection from patients receiving iodinated or gadolinium-based contrast media must be avoided for a minimum of 72 hours post-exposure
  • High concentrations of barium are known to interfere with this test. If barium-containing contrast media has been administered, a specimen should not be collected for 96 hours.
  • Collection from patients with impaired kidney function should be avoided for a minimum of 14 days post contrast media exposure.
  • Patients should avoid sea/fresh water fish 3 days prior to specimen collection

Specimen Collection: 24 hour urine specimen must be collected in a plastic container. 10 mL (5 mL min.) aliquot of 24 hour urine collected in acid washed (metal free) container kit available. Mix thoroughly. Transfer 10 mL aliquot to vial provided in the kit. Measure 24 hour total volume and record on vial and test request form

Storage: Refrigerated, Room temperature or frozen

Stability: Stability Room 24 hrs
Stability Refrigerated 48 hrs
Stability Frozen 1 week

Report Availability: 1-5 days

More Details: Zinc is an essential element which acts as a critical co-factor in various enzyme systems and is required for active wound healing. Zinc deficiency occurs due to lack of dietary absorption or loss after absorption. Zinc excess is not a major clinical concern. The only known effect of excessive zinc ingestion is interference with copper absorption leading to hypocupremia. This assay is useful for identifying the cause of abnormal serum zinc. Fecal excretion of zinc is the dominant route of elimination. Renal excretion is a minor, secondary elimination pathway. Normal daily excretion of zinc in the urine is in the range of 20 to 967 mcg/24 hours. High urine zinc associated with low serum zinc may be caused by hepatic cirrhosis, neoplastic disease, or increased catabolism. High urine zinc with normal or elevated serum zinc indicates a large dietary source, usually in the form of high-dose vitamins. Low urine zinc with low serum zinc may be caused by dietary deficiency or loss through exudation common in burn patients and those with gastrointestinal losses

Clinic Hours
In Article, COVID-19

COVID-19 coronavirus vaccine tracker

Researchers worldwide are working around the clock to find a vaccine against SARS-CoV-2, the virus causing the COVID-19 pandemic. Experts estimate that a fast-tracked vaccine development process could speed a successful candidate to market in approximately 12-18 months.

How are vaccines tested?

  • In the pre-clinical stage of testing, researchers give the vaccine to animals to see if it triggers an immune response.
  • In phase 1 of clinical testing, the vaccine is given to a small group of people to determine whether it is safe and to learn more about the immune response it provokes.
  • In phase 2, the vaccine is given to hundreds of people so scientists can learn more about its safety and correct dosage.
  • In phase 3, the vaccine is given to thousands of people to confirm its safety – including rare side effects – and effectiveness. These trials involve a control group which is given a placebo.

Vaccines in clinical trials

  • Sinovac: Chinese company Sinovac is developing a vaccine based on inactivated Covid-19 particles. The vaccine has shown a promising safety profile in the early stages of testing and is now moving into Phase 3 trials in Brazil.
  • The Murdoch Children’s Research Institute in Australia is conducting a phase 3 trial using a nearly 100-year-old tuberculosis vaccine. The vaccine is not thought to protect directly against Covid-19 but might boost the body’s non-specific immune response.
  • University of Oxford/AstraZeneca: The University of Oxford vaccine is delivered via a chimpanzee virus, called the vaccine vector. The vector contains the genetic code of the protein spikes found on the coronavirus and triggers a strong immune response in the human body. The vaccine is in a combined phase 2/3 trial in the UK and has recently gone into phase 3 trials in South Africa and Brazil.
    CanSino Biologics Inc./Beijing Institute of Biotechnology
    The vaccine developed by Chinese company CanSino Biologics and the Beijing Institute of Biotechnology – a university close to the Chinese military – reportedly showed promising results in phase 2 testing, although no data from the trial has been published. In a world first, the vaccine has now been approved for military use, but it is unclear how broadly it will be distributed.
  • Moderna/NIAID: American biotech company Moderna is developing a vaccine candidate using messenger RNA (or mRNA for short) to trick the body into producing viral proteins itself. No mRNA vaccine has ever been approved for an infectious disease, and Moderna has never brought a product to market. But proponents of the vaccine say it could be easier to mass produce than traditional vaccines.
  • Inovio Pharmaceuticals/ International Vaccine Institute
  • Cadila Healthcare Limited
  • Wuhan Institute of Biological Products/Sinopharm
  • Beijing Institute of Biological Products/Sinopharm
  • Novavax
  • BioNTech/Fosun Pharma/Pfizer
  • Genexine Consortium
  • Osaka University/ AnGes/ Takara Bio
  • Institute of Medical Biology, Chinese Academy of Medical Sciences
  • Gamaleya Research Institute
  • Clover Biopharmaceuticals Inc./GSK/Dynavax
  • Anhui Zhifei Longcom Biopharmaceutical/ Institute of Microbiology,
  • Chinese Academy of Sciences
  • Vaxine Pty Ltd/Medytox
  • Imperial College London
  • Curevac
  • People’s Liberation Army (PLA) Academy of Military Sciences/Walvax Biotech.
  • Medicago Inc./ Université Laval
  • University of Melbourne/Murdoch Children’s Research Institute

Draft landscape of COVID-19 candidate vaccines by WHO: Download PDF ›

Source: WHO

Clinic Hours
In Article, New Drug

FDA approves Collagenase Clostridium Histolyticum for Cellulite

The FDA has approved collagenase clostridium histolyticum for the treatment of moderate to severe cellulite in the buttocks of adult women. The drug is the first injectable treatment for cellulite to receive regulatory approval.

Dose: 0.9mg Solution, Injection

MOA: When injected into the treatment area, It is thought to release the fibrous septae enzymatically by specifically targeting types 1 and 3 collagen, which may result in the smoothing of the skin and an improved appearance of cellulite.

Common side effects: Injection site bruising, pain, areas of hardness, itching, redness, discoloration, swelling, and warmth in the treatment area.

In cellulite, fibrous septae are a primary contributing factor. The septae make up the fibrous connective tissue that connects the skin perpendicularly to the fascia below and tether the skin, drawing it downward and leading to a mattress-like appearance, commonly referred to as “dimpling.”

Clinic Hours
In Article, COVID-19

Cutaneous manifestations of COVID-19

Observed COVID-19 associated skin patterns were:

  • Acral erythema with vesicles or pustules; so-called “pseudo-chilblains”  or “COVID Toes” (19%)
  • Vesicular (chicken pox-like) eruptions (9%)
  • Maculopapular eruptions (47%)
  • Urticaria (19%)
  • Livedo or necrosis (6%)

1. Acral areas of erythema-oedema with some vesicles or pustules (pseudo-chilblain) (19% of cases).

These lesions, affecting hands and feet, may resemble chilblains (small, itchy swellings on the skin) with small red or purple spots, caused by bleeding under the skin. They were usually asymmetrical.

Associated with: younger patients, lasted for a mean of 12.7 days, took place later in the course of the COVID-19 disease and was associated with less severe disease (in terms of hospital admission, pneumonia, intensive care unit admission or mortality). They could cause pain (32%) or itch (30%).

2. Other vesicular eruptions (9%).

Vesicular eruptions are outbreaks of small blisters, some of these presented on the trunk. They may also affect the limbs, may be filled with blood, and become larger or more spread out.

Associated with: middle aged patients, lasted for a mean of 10.4 days, appeared more commonly (15%) before other symptoms and were associated with intermediate severity. Itching was common (68%).

3. Urticarial lesions (19%):

These consist of pink or white raised areas of skin resembling nettle rash, known as wheals (also spelled weals), which are usually itchy. Mostly distributed in the trunk or spread across the body. A few cases were on the palms of the hands. Associated with: see below ‘4. Other maculopapules’

4. Other maculopapules (47%).

Maculopapules are small, flat and raised red bumps. In some cases these were distributed around hair follicles, there was also varying degrees of scaling. Some had been described as similar to pityriasis rosea, a common skin condition. Blood spots under the skin may also be present, either in the form of spots/dots or on larger areas.

Associated with: lasting for a shorter period (6.8 days mean for urticarial and 8.6 for maculopapular), usually appeared at the same time than the rest of the symptoms and were associated with more severe COVID-19 disease (2% mortality in the sample). Itching was very common for urticariform lesions (92%) and 57% for maulopapular.

5. Livedo or necrosis (6%).

Livedo is a skin condition where circulation in the blood vessels of the skin is impaired. It causes the skin to take on a blotchy red or blue appearance with a retiform (net-like) pattern. Necrosis refers to the premature death of skin tissue. These patients showed different degrees of lesions suggesting occlusive vascular disease, where a narrowing or blocking of arteries occurs, limiting blood flow to certain areas of the body (in this case the trunk or extremities).

Associated with: older patients with more severe disease (10% mortality). However, the manifestations of COVID-19 in this group were more variable, including transient livedo, with some suffering COVID-19 that did not require hospitalisation.

Source: Medscape, skinhealthinfo.org.uk

Clinic Hours
In Article

Triple therapy for COPD

Triple fixed-dose regimens of an inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA), and a long-acting β2-agonist (LABA) for chronic obstructive pulmonary disease (COPD) have been studied at single-dose levels of inhaled glucocorticoid, but studies at two dose levels are lacking.

Triple therapy with twice-daily budesonide (at either the 160-μg or 320-μg dose), glycopyrrolate, and formoterol resulted in a lower rate of moderate or severe COPD exacerbations than glycopyrrolate–formoterol or budesonide–formoterol.

Case study: The modified intention-to-treat population comprised of 8509 patients. The annual rates of moderate or severe exacerbations were 1.08 in the 320-μg–budesonide triple-therapy group (2137 patients), 1.07 in the 160-μg–budesonide triple-therapy group (2121 patients), 1.42 in the glycopyrrolate–formoterol group (2120 patients), and 1.24 in the budesonide–formoterol group (2131 patients). The rate was significantly lower with 320-μg–budesonide triple therapy than with glycopyrrolate–formoterol (24% lower: rate ratio, 0.76; 95% confidence interval [CI], 0.69 to 0.83; P<0.001) or budesonide–formoterol (13% lower: rate ratio, 0.87; 95% CI, 0.79 to 0.95; P=0.003). Similarly, the rate was significantly lower with 160-μg–budesonide triple therapy than with glycopyrrolate–formoterol (25% lower: rate ratio, 0.75; 95% CI, 0.69 to 0.83; P<0.001) or budesonide–formoterol (14% lower: rate ratio, 0.86; 95% CI, 0.79 to 0.95; P=0.002). The incidence of any adverse event was similar across the treatment groups (range, 61.7 to 64.5%); the incidence of confirmed pneumonia ranged from 3.5 to 4.5% in the groups that included inhaled glucocorticoid use and was 2.3% in the glycopyrrolate–formoterol group

Source: NEJM.org

Clinic Hours
In Drug

Fostemsavir

Rx Prescription Required

Classes: Antiretroviral Agents, gp120 attachment inhibitor, Pyridines & derivatives

Uses: Multidrug-resistant HIV-1 infection 

Administration: Oral (600 mg extended-release tablets)

Dosages ›
Interactions ›
Adverse Effects ›
Warnings ›
Safety Advice ›
Pharmacology ›
General Considerations ›
Monitoring Parameters ›

Rukobia

Manufacturer: ViiV Healthcare Ltd (majority-owned by GlaxoSmithKline, with Pfizer & Shionogi as shareholders)

Salt Composition: Fostemsavir (600mg)

Price: NA

No drug combination found

Dosages

HIV-1 Infection

  • 600mg BD in combination with other antiretrovirals
  • It is indicated for the treatment of HIV-1 infection in heavily treatment-experienced adults with multidrug-resistant HIV-1 infection failing their current antiretroviral regimen due to resistance, intolerance, or safety considerations
  • The extended-release tablet contains 600 mg of fostemsavir (equivalent to 725 mg of fostemsavir tromethamine)

The safety and effectiveness of Fostemsavir have not been established in pediatric patients

Interactions

Contraindicated

  • Enzalutamide
  • Carbamazepine
  • Phenytoin
  • Rifampin
  • MitotaneSt John’s wort (Hypericum perforatum)

Serious

  • Grazoprevir
  • Voxilaprevir

Monitor Closely

  • Ethinyl estradiol
  • Rosuvastatin
  • Atorvastatin
  • Fluvastatin
  • Pitavastatin
  • Simvastatin

Adverse Effects

  • Nausea 10%
  • Diarrhoea 4%
  • Headache 4%
  • Abdominal pain 3%
  • Dyspepsia 3%
  • Fatigued 3%
  • Rash 3%
  • Sleep disturbance 3%
  • Immune Reconstitution Inflammatory Syndrome 2%
  • Somnolence 2%
  • Vomiting 2%
  • Elevations in hepatic transaminases in patients with hepatitis B or C virus co-infection: Elevations in hepatic transaminases were observed in a greater proportion of subjects with HBV and/or HCV co-infection compared with those with HIV mono-infection.
  • Risk of Adverse Reactions or Loss of Virologic Response Due to Drug Interactions: The concomitant use of fostemsavir and certain other drugs may result in known or potentially significant drug interactions, some of which may lead to 1) Loss of therapeutic effect of fostemsavir and possible development of resistance due to reduced exposure of temsavir 2) Possible prolongation of QTc interval from increased exposure to temsavir.

Less common adverse reactions

  • Cardiac Disorders: Electrocardiogram QT prolonged, Torsade de Pointes
  • Musculoskeletal Disorders: Myalgia.
  • Nervous System Disorders: Dizziness, dysgeusia, neuropathy peripheral (includes pooled terms: neuropathy peripheral and peripheral sensory neuropathy).
  • Skin and Subcutaneous Tissue Disorders: Pruritus.

Contraindications & Warnings

Immune Reconstitution Syndrome

  • Immune reconstitution syndrome has been reported in patients. During the initial phase of combination antiretroviral treatment, patients whose immune systems respond may develop an inflammatory response to indolent or residual opportunistic infections (such as Mycobacterium avium infection, cytomegalovirus, Pneumocystis jirovecii pneumonia [PCP], or tuberculosis), which may necessitate further evaluation and treatment.
  • Autoimmune disorders (such as Graves’ disease, polymyositis, Guillain-Barré syndrome, and autoimmune hepatitis) have also been reported to occur in the setting of immune reconstitution; however, the time to onset is more variable and can occur many months after initiation of treatment

QTc Prolongation

  • Seen with higher than recommended dosages at 2,400 mg twice daily, 4 times the recommended daily dose, has been shown to significantly prolong the QTc interval of the electrocardiogram

Safety Advice

🍺   Alcohol: Caution

🤰🏻   Pregnancy: Insufficient human data

🤱🏻   Breastfeeding: Unsafe

🚗   Driving: Safe

 Kidney: Safe

 Liver: Safe

 

Pharmacology

Mechanism of Action

  • Fostemsavir tromethamine is a prodrug of temsavir is a first-in-class HIV-1 attachment inhibitor. After oral administration, fostemsavir is converted to temsavir, which is then absorbed and exerts antiviral activity by attaching directly to the glycoprotein 120 (gp120) subunit on the surface of the virus, thereby blocking HIV from attaching to host immune system CD4+ T-cells and preventing the virus from infecting those cells and multiplying. As fostemsavir is the first antiretroviral therapy to target this step of the viral cycle, there is no demonstrated resistance to other classes of antiretrovirals, which may help patients who have become resistant to most other medicines.

About Temsavir

  • Temsavir  is a substrate of CYP3A, esterases, P-glycoprotein (P-gp), and breast cancer resistance protein (BCRP).
  • Coadministration of fostemsavir with drugs that are strong CYP3A inducers result in decreased concentrations of temsavir.
  • Coadministration of fostemsavir with drugs that are moderate CYP3A inducers and/or strong CYP3A, P-gp and/or BCRP inhibitors are not likely to have a clinically relevant effect on the plasma concentrations of temsavir. Temsavir is an inhibitor of OATP1B1 and OATP1B3.

Pharmacokinetic properties of Temsavir

  • Absolute bioavailability: 26.9%
  • Distribution: Plasma protein binding 88.4%
  • Major route of elimination: Metabolism
  • Half-life: 11 hours
  • Metabolic pathwayse: Hydrolysis (esterases) [36.1% of oral dose], Oxidation (CYP3A4) [21.2% of oral dose], UGT [<1% of oral dose]
  • Excretion: Urine (unchanged drug) 51 %, feces (unchanged drug) 33%, bile 5%

General Considerations

  • Advise the patient to read the FDA-approved patient labeling (Patient Information).
  • Hypersensitivity Reactions
  • Immune Reconstitution Syndrome: Advice patients to inform their healthcare provider immediately of any signs and symptoms of
    infection, as inflammation from the previous infection, may occur soon after combination antiretroviral therapy, including when fostemsavir is started
  • QTc Interval Prolongation: Advise patients that it may produce changes in their electrocardiogram (i.e., QT prolongation). Instruct patients to consult their healthcare provider if they experience symptoms such as dizziness, lightheadedness, abnormal heart rhythm, or loss of consciousness
  • Patients with Hepatitis B or C Virus Co-infection: Advise patients that it is recommended to have laboratory testing and to take medications for
    HBV or HCV as prescribed
  • Drug Interactions: Fostemsavir may interact with other drugs; therefore, advise patients to report to their healthcare provider the use of any other prescription or nonprescription medication or herbal products,
    including St. John’s wort
  • Pregnancy Registry: Inform patients that there is an antiretroviral pregnancy registry to monitor fetal outcomes in those exposed to fostemsavir during pregnancy.
  • Instruct mothers with HIV-1 infection not to breastfeed because HIV-1 can be passed to the baby in the breast milk
  • Potential Odor of Tablets: Tablets may have a slight vinegar-like odour
  • Missed Dosage: Advise patients to avoid missing doses as it can result in the development of resistance. Instruct patients that if they miss a dose of fostemsavir, to take it as soon as they remember. Advise
    patients not to double their next dose or take more than the prescribed dose

General Monitoring Parameters

  • ECG for estimation of QT interval
  • CBC at baseline with periodic tests for liver function, renal function, blood glucose level
  • CD4 count

Report an error

Clinic Hours
In Article, COVID-19

WHO warns of oxygen shortage as COVID cases set to 10 million

The world faces a shortage of oxygen concentrators as the number of worldwide cases of coronavirus infection nears the 10 million. COVID-19 Tracker ›

“Many countries are now experiencing difficulties obtaining oxygen concentrators,” WHO Director General Tedros Adhanom Ghebreyesus told a news conference. “Demand is currently outstripping supply.”

The sudden rise has created a dearth of oxygen concentrators needed to support breathing of COVID-19 patients suffering from respiratory distress.

The health agency has purchased 14,000 oxygen concentrators from manufacturers and plans to send them to 120 countries in coming weeks, Tedros said. A further 170,000 concentrators – valued at some $100 million – will be potentially available over the next six months.

The head of the WHO emergencies programme, Dr Mike Ryan, meanwhile said the pandemic in many Latin American countries was still intense as deaths in the region surpassed 100,000 this week. Many countries had experienced 25-50% increases in cases in the past week, he said.

Source: Reuters

Clinic Hours
In Article

Gilead prices Remdesivir at $2,340 for a five-day treatment

Gilead Sciences Inc has priced its COVID-19 drug candidate remdesivir at $2,340 for a five-day treatment in the United States and some other developed countries, potentially reflecting looming competition from a cheap steroid.

Remdesivir is at the forefront of the fight against COVID-19 after the anti-viral treatment helped shorten hospital recovery times in a clinical trial. It has been approved for emergency use in some patients in the United States.

The remdesivir price for U.S. private insurance companies will be $520 per vial, Gilead said, which equates to $3,120 per patient for a treatment course of six vials.

Gilead has linked up with generic drugmakers based in India and Pakistan, including Cipla Ltd and Hetero Labs Ltd, to make and supply remdesivir in 127 developing countries.

Cipla’s version is priced at less than 5,000 Indian rupees ($66.24), while Hetero Lab’s version is priced at 5,400 rupees.

Source: Medscape

Clinic Hours
In Article, New Drug

FDA approves atezolizumab + bevacizumab for advanced HCC

The US Food and Drug Administration (FDA) has approved Tecentriq® (atezolizumab) in combination with Avastin® (bevacizumab) for the treatment of people with unresectable or metastatic hepatocellular carcinoma (HCC) who have not received prior systemic therapy.

Atezolizumab is a monoclonal antibody designed to bind with a protein called PD-L1, which is expressed on tumour cells and tumour-infiltrating immune cells, blocking its interactions with both PD-1 and B7.1 receptors. By inhibiting PD-L1, it may enable the activation of T-cells.

Bevacizumab is a biologic antibody designed to specifically bind to a protein called VEGF that plays an important role throughout the lifecycle of the tumour to develop and maintain blood vessels, a process known as angiogenesis. It is designed to interfere with the tumour blood supply by directly binding to the VEGF protein to prevent interactions with receptors on blood vessel cells. The tumour blood supply is thought to be critical to a tumour’s ability to grow and spread in the body (metastasis).

Source: Roche, fda.gov

Clinic Hours
In Drug

Hydroxychloroquine Sulfate (HCQ)

Rx Prescription Required

Classes: Aminoquinoline, Antimalarials, DMARDs, Immunosuppressants, Cytochrome P-450 CYP2D6 Inhibitors

Uses: Uncomplicated malaria, rheumatoid arthritis, chronic discoid lupus erythematosus, systemic lupus erythematosus, COVID-19*

Administration: Oral (Take with a meal or a glass of milk)

Dosages ›
Interactions ›
Adverse Effects ›
Warnings ›
Safety Advice ›
Pharmacology ›
General Considerations ›
Monitoring Parameters ›

Auto Q 200mg Tablet

Manufacturer: Regenix Drugs Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 60.25 (10 tablets in 1 strip) ₹6.02/Tablet

Axemal Tablet

Manufacturer: Obsurge Biotech Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 64.95 (10 tablets in 1 strip) ₹6.49/Tablet

Bioquin 200mg Tablet

Manufacturer: Ipca Laboratories Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 68 (10 tablets in 1 strip) ₹6.8/Tablet

Cartiquin 200mg Tablet

Manufacturer: Overseas Healthcare Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 65.4 (10 tablets in 1 strip) ₹6.5/Tablet

Cartiquin 300mg Tablet

Manufacturer: Overseas Healthcare Pvt Ltd

Salt Composition: Hydroxychloroquine (300mg)

Price: Rs 132.5 (10 tablets in 1 strip) ₹13.2/Tablet

Cartiquin 400mg Tablet

Manufacturer: Overseas Healthcare Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 107.7 (10 tablets in 1 strip) ₹10.7/Tablet

CoviQ Tablet

Manufacturer: Zydus Cadila

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 55.9 (10 tablets in 1 strip) ₹5.59/Tablet

Chloro QS 200mg Tablet

Manufacturer: Cmg Biotech Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 69.5 (10 tablets in 1 strip) ₹6.95/Tablet

Deng 200mg Tablet

Manufacturer: East West Pharma

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 57.75 (10 tablets in 1 strip) ₹5.7/Tablet

Dmd 200mg Tablet

Manufacturer: Zoic Lifesciences

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 59 (10 tablets in 1 strip) ₹5.9/Tablet

Dxq 200mg Tablet

Manufacturer: Nahren Lifesciences

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 62.2 (10 tablets in 1 strip) ₹6.2/Tablet

Dxq 300mg Tablet

Manufacturer: Nahren Lifesciences

Salt Composition: Hydroxychloroquine (300mg)

Price: Rs 115 (10 tablets in 1 strip) ₹11.5/Tablet

Era-H 200mg Tablet

Manufacturer: TBG pharma ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 62 (10 tablets in 1 strip) ₹6.2/Tablet

Had Q 200mg Tablet

Manufacturer: UHC Life Sciences

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 65.45 (10 tablets in 1 strip) ₹6.54/Tablet

HCQS 200 Tablet

Manufacturer: Ipca Laboratories Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 99.29 (15 tablets in 1 strip) ₹6.62/Tablet

HCQS 300 Tablet

Manufacturer: Ipca Laboratories Ltd

Salt Composition: Hydroxychloroquine (300mg)

Price: Rs 152.95 (10 tablets in 1 strip) ₹15.29/Tablet

HCQS 400 Tablet

Manufacturer: Ipca Laboratories Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 133 (10 tablets in 1 strip) ₹13.34/Tablet

Hikem Tablet

Manufacturer: Bioceutics Inc

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 70 (10 tablets in 1 strip) ₹7/Tablet

HQ 200mg Tablet

Manufacturer: Vasu Organics Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 55 (10 tablets in 1 strip) ₹5.5/Tablet

HQ 400mg Tablet

Manufacturer: Vasu Organics Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 10.3 (10 tablets in 1 strip) ₹10/Tablet

Hqra 200mg Tablet

Manufacturer: Rhumasafe Pharmaceutical

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 62 (10 tablets in 1 strip) ₹6.2/Tablet

Hqra 300mg Tablet

Manufacturer: Rhumasafe Pharmaceutical

Salt Composition: Hydroxychloroquine (300mg)

Price: Rs 110 (10 tablets in 1 strip) ₹11/Tablet

Hqra 400mg Tablet

Manufacturer: Rhumasafe Pharmaceutical

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 120 (10 tablets in 1 strip) ₹12/Tablet

Hqtor Tablet

Manufacturer: Torrent Pharmaceuticals Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 64.9 (10 tablets in 1 strip) ₹6.49/Tablet

Hqtor 400 Tablet

Manufacturer: Torrent Pharmaceuticals Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 130 (10 tablets in 1 strip) ₹13/Tablet

H-Quine 200mg Tablet

Manufacturer: Ankaa Pharmaceutical

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 58 (10 tablets in 1 strip) ₹5.8/Tablet

Hqwin 200mg Tablet

Manufacturer: Orsim Pharma

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 59 (10 tablets in 1 strip) ₹5.9/Tablet

Hydrocad 200mg Tablet

Manufacturer: Cadila Pharmaceuticals Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 60.48 (10 tablets in 1 strip) ₹60/Tablet

Hydroquin 200mg Tablet

Manufacturer: Sun Pharmaceutical Industries Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 60 (10 tablets in 1 strip) ₹6/Tablet

Hydroquin 400mg Tablet

Manufacturer: Sun Pharmaceutical Industries Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 125 (10 tablets in 1 strip) ₹12.5/Tablet

Hydrowin 200mg Tablet

Manufacturer: Ikon Remedies Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 59.22 (10 tablets in 1 strip) ₹5.92/Tablet

Hydrowin 400mg Tablet

Manufacturer: Ikon Remedies Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 106.26 (10 tablets in 1 strip) ₹10.6/Tablet

HYQ 400 Tablet

Manufacturer: Ipca Laboratories Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 133 (10 tablets in 1 strip) ₹13.34/Tablet

Imulast 200mg Tablet

Manufacturer: Cipla Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 65.8 (10 tablets in 1 strip) ₹6.5/Tablet

Imulast 400mg Tablet

Manufacturer: Cipla Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 125 (10 tablets in 1 strip) ₹12.5/Tablet

Kaiquin 200mg Tablet

Manufacturer: Kaizen Research Labs India Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 51 (10 tablets in 1 strip) ₹5.1/Tablet

Ketor 200mg Tablet

Manufacturer: Chemo Healthcare Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 60 (10 tablets in 1 strip) ₹6/Tablet

Latvitor 200 Tablet

Manufacturer: Osiante Biotech

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 90.38 (15 tablets in 1 strip) ₹6.03/Tablet

Mcqs 200mg Tablet

Manufacturer: Molekule India Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 69.9 (10 tablets in 1 strip) ₹6.99/Tablet

Nid-Q 200mg Tablet

Manufacturer: Nidus Pharma Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 56 (10 tablets in 1 strip) ₹5.6/Tablet

Numi HQ 200mg Tablet

Manufacturer: Nusmith Pharma Pvt. Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 67.5 (10 tablets in 1 strip) ₹6.75/Tablet

Orthokind 200mg Tablet

Manufacturer: Mankind Pharma Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 69.9 (10 tablets in 1 strip) ₹6.99/Tablet

Oxcq 200 Tablet

Manufacturer: Wallace Pharmaceuticals Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 66.14 (10 tablets in 1 strip) ₹6.61/Tablet

Oxcq 300 Tablet

Manufacturer: Wallace Pharmaceuticals Pvt Ltd

Salt Composition: Hydroxychloroquine (300mg)

Price: Rs 111.87 (10 tablets in 1 strip) ₹11/Tablet

P Hyd 200mg Tablet

Manufacturer: Parry Pharma Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 60 (10 tablets in 1 strip) ₹6/Tablet

Paxoquin 200mg Tablet

Manufacturer: Pax Healthcare

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 68 (10 tablets in 1 strip) ₹6.8/Tablet

Plaquenil

Manufacturer: Sanofi‐Synthelabo Inc

Salt Composition: Hydroxychloroquine (200mg)

Price: $96.38 (30 tablets in 1 strip) 

Qcq 200mg Tablet

Manufacturer: Femgrace Formulations

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 62.5 (10 tablets in 1 strip) ₹6.25/Tablet

Qdmrd 200 Tablet

Manufacturer: Alembic Pharmaceuticals Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 64.92 (10 tablets in 1 strip) ₹6.49/Tablet

Qdmrd 400 Tablet

Manufacturer: Alembic Pharmaceuticals Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 126 (10 tablets in 1 strip) ₹12.6/Tablet

Qslera 200mg Tablet

Manufacturer: Renauxe Pharma India Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 60 (10 tablets in 1 strip) ₹6/Tablet

Qurion 200mg Tablet

Manufacturer: Ernst Pharmacia

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 90.39 (15 tablets in 1 strip) ₹6.03/Tablet

Qyn 200mg Tablet

Manufacturer: FDC Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 58.4 (10 tablets in 1 strip) ₹5.84/Tablet

Q-Rado 400mg Tablet

Manufacturer: El-Dorado Bio-Tech Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 94.3 (10 tablets in 1 strip) ₹9.4/Tablet

Racq 200mg Tablet

Manufacturer: Doctors Choice Health Care India Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 93 (15 tablets in 1 strip) ₹6.2/Tablet

Ra Quin 200mg Tablet

Manufacturer: Sun Pharmaceutical Industries Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 67.5 (10 tablets in 1 strip) ₹6.7/Tablet

Rarex 200mg Tablet

Manufacturer: Molekule India Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 56.4 (10 tablets in 1 strip) ₹5.6/Tablet

Rhq 200mg Tablet Discontinued

Manufacturer: Abbott Laboratories

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 60.48 (10 tablets in 1 strip) ₹6.04/Tablet

RHQ 400mg Tablet Discontinued

Manufacturer: Abbott Laboratories

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 114 (10 tablets in 1 strip) ₹11/Tablet

Riva QS 200mg Tablet

Manufacturer: Achilles Healthcare Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 97 (15 tablets in 1 strip) ₹6.47/Tablet

Rumawill 200mg Tablet

Manufacturer: Mediwill Life Sciences

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 56 (10 tablets in 1 strip) ₹5.6/Tablet

Rutor 200mg Tablet

Manufacturer: Chemo Biological

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 80 (10 tablets in 1 strip) ₹8/Tablet

Vohq 200mg Tablet

Manufacturer: Vasu Organics Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 64.9 (10 tablets in 1 strip) ₹6.49/Tablet

Vohq 400mg Tablet

Manufacturer: Vasu Organics Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 118.65 (10 tablets in 1 strip) ₹11.8/Tablet

Winflam 200mg Tablet

Manufacturer: Micro Labs Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 65 (10 tablets in 1 strip) ₹6.5/Tablet

Yadrox 200mg Tablet

Manufacturer: Trireme Life Sciences Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 62.5 (10 tablets in 1 strip) ₹6.25/Tablet

Ydro 200mg Tablet

Manufacturer: Arvincare Pharma

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 62.5 (10 tablets in 1 strip) ₹6.25/Tablet

Ydro 400mg Tablet

Manufacturer: Arvincare Pharma

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 160 (10 tablets in 1 strip) ₹16/Tablet

Zhquine 200mg Tablet

Manufacturer: Ambience Pharma

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 56.3 (10 tablets in 1 strip) ₹5.63/Tablet

Zhquine 400mg Tablet

Manufacturer: Ambience Pharma

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 112 (10 tablets in 1 strip) ₹11.2/Tablet

Zy-Q 200 Tablet

Manufacturer: Zydus Cadila

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 167.87 (30 tablets in 1 bottle) ₹5.6/Tablet

Zy-Q 300 Tablet

Manufacturer: Zydus Cadila

Salt Composition: Hydroxychloroquine (300mg)

Price: Rs 425.1 (30 tablets in 1 strip) ₹14.17/Tablet

Zy-Q 400 Tablet

Manufacturer: Zydus Cadila

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 392.72 (30 tablets in 1 strip) ₹13.09/Tablet

No drug combination found

Dosages

Rheumatoid Arthritis

  • Oral dose: 400 mg OD dose or in 2 divided doses 200mg BD, with or without concomitant non-biologic disease-modifying antirheumatic drugs  
  • Maintenance: 300 mg OD (usually after 3 months of initial dosing) and continue maintenance dose of 200-400 mg/day (155-310 mg base/day) PO as a qDay or in BID; not exceed 600 mg or 6.5 mg/kg (5 mg/kg base) per day due to the risk of retinal toxicity

Coronavirus disease 2019 (COVID-19) Treatment

  • Oral Initial dose: 400 mg BID, for 1 day in combination with azithromycin
  • Maintenance dose: 200 mg BID, for 4 days
  • In patients with severe disease and requiring ICU management (MoHFW India, March 2020). It should be administered under close medical supervision, with monitoring for side effects, including QTc interval prolongation. Not recommended in pregnant and lactating women

Coronavirus disease 2019 (COVID-19) Prophylaxis (ICMR 22 May 2020)

  • Oral Initial dose: 400 mg BID, on day 1
  • Maintenance dose: 400 mg once weekly for the next 7 weeks, taken with a meal
  • Asymptomatic healthcare workers involved in containment and treatment  of COVID-19 or working in non-COVID hospitals/non-COVID areas of COVID hospitals/blocks as well as asymptomatic frontline workers deployed in containment zones and paramilitary/police personnel involved in COVID-19 related-activities

Coronavirus disease 2019 (COVID-19) Prophylaxis for Asymptomatic household contacts of laboratory-confirmed cases

  • Oral Initial dose: 400 mg BID, on day 1
  • Maintenance dose: 400 mg once weekly for the next 3 weeks taken with meals

Malaria Prophylaxis

  • Oral dose: 400 mg (310 mg base) PO weekly, starting 2 weeks before exposure and continued for 4 weeks after departure from endemic area OR
  • Weight-based dosing: 6.5 mg/kg (5 mg/kg base) PO once weekly, not to exceed 400 mg (310 mg base), starting 2 weeks before exposure and continued for 4 weeks after leaving the endemic area

Acute treatment for Uncomplicated Malaria due to P falciparum, P malariae, P ovale, and P viva

  • Oral dose: 800 mg (620 mg base) OD, then 400 mg (310 mg base) OD at 6 hr, 24 hr, and 48 hr after initial dose OR
  • Weight-based dosing: 13 mg/kg (10 mg/kg base), not to exceed 800 mg (620 mg base) followed by 6.5 mg/kg (5 mg/kg base), not to exceed 400 mg (310 mg base), PO at 6 hr, 24 hr, and 48 hr after initial dose

Systemic Lupus Erythematosus

  • Oral dose: 200-400 mg/day (155-310 mg base/day) OD as a single daily dose or in two divided doses
  • Doses >400 mg/day are not recommended. Incidence of retinopathy has been reported to be higher when this maintenance dose is exceeded

Porphyria cutanea tarda (off-label use)

  • Oral dose: 100 mg twice weekly continue until plasma porphyrin levels are normal for at least one month

Primary Sjögren syndrome (extra-glandular manifestations) (off-label use)

  • Oral dose: 200–400 mg OD, or in two divided doses
  • Due to the risk of retinal toxicity, do not exceed a daily dose of 5 mg/kg/day using actual body weight or 400 mg

Q fever, chronic (off-label use)

  • Oral dose: 600 mg/day in 1 or 3 divided doses in combination with doxycycline for ≥18 months depending on site of infection and serologic response

Prevention of persistent infection following acute Q fever

  • Oral dose: 600 mg/day in 1 or 3 divided doses in combination with doxycycline for 12 months

Lupus erythematosus (off-label dose)

  • Oral dose: 200–400 mg OD or in 2 divided doses

Juvenile rheumatoid arthritis (JRA) or systemic lupus erythematosus (SLE)

  • Oral dose: 3–5 mg/kg/day divided 1–2 times/day to a maximum of 400 mg/day, not to exceed 7 mg/kg/day

Coronavirus disease 2019 (COVID-19) Treatment for adolescents >12 years with severe disease and requiring ICU management (MoHFW India, March 2020)

  • Oral Initial dose: 400 mg BID, for 1 day in combination with azithromycin
  • Maintenance dose: 200 mg BID, for 4 days
  • Should be administered under close medical supervision, with monitoring for side effects, including QTc interval prolongation

Acute attack of Uncomplicated Malaria treatment for Infants, children, and adolescents

  • Oral dose: 13 mg/kg/dose (maximum initial dose: 800 mg/dose), followed by 6.5 mg/kg at 6, 24, and 48 hours after the initial dose (maximum dose: 400 mg/dose)

Malaria Chemoprophylaxis for Infants, children, and adolescents

  • Oral dose: 6.5 mg/kg once weekly on the same day each week; maximum dose: 400 mg/dose, begin 1–2 weeks  before exposure 
  • Continue for at least 4 weeks after leaving the endemic area 
  • If the initiation of chemoprophylaxis is delayed (i.e. 2 weeks of therapy not completed prior to the exposure), initiate therapy by doubling the initial dose (13 mg/kg) and administering in 2 divided doses 6 h apart; maximum single dose: 400 mg/dose; continue for 8 weeks after leaving the endemic area

Interactions

Contraindicated

  • lefamulin

Serious

  • adalimumab
  • alefacept
  • alfuzosin
  • amiodarone
  • amitriptyline
  • amoxapine
  • anakinra
  • anthrax vaccine
  • antithymocyte globulin equine
  • antithymocyte globulin rabbit
  • apomorphine
  • arformoterol
  • arsenic trioxide
  • artemether/lumefantrine
  • asenapine
  • azathioprine
  • azithromycin
  • basiliximab
  • BCG vaccine live
  • bedaquiline
  • canakinumab
  • chlorpromazine
  • ciprofloxacin
  • cisapride
  • citalopram
  • clarithromycin
  • clofazimine
  • clomipramine
  • clozapine
  • crizotinib
  • cyclosporine
  • dapsone topical
  • dasatinib
  • degarelix
  • desipramine
  • deutetrabenazine
  • digoxin
  • diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine
  • disopyramide
  • dofetilide
  • dolasetron
  • dronedarone
  • droperidol
  • encorafenib
  • entrectinib
  • eribulin
  • erythromycin base
  • erythromycin ethylsuccinate
  • erythromycin lactobionate
  • erythromycin stearate
  • escitalopram
  • etanercept
  • everolimus
  • ezogabine
  • flecainide
  • fluconazole
  • fluoxetine
  • fluphenazine
  • formoterol
  • foscarnet
  • gemifloxacin
  • gemtuzumab
  • glasdegib
  • glatiramer
  • golimumab
  • haloperidol
  • hepatitis A vaccine inactivated
  • hepatitis a/b vaccine
  • hepatitis a/typhoid vaccine
  • hepatitis b vaccine
  • human papillomavirus vaccine, nonavalent
  • human papillomavirus vaccine, quadrivalent
  • ibutilide
  • iloperidone
  • indacaterol (Inhaled)
  • indapamide
  • infliximab
  • influenza virus vaccine quadrivalent
  • influenza virus vaccine quadrivalent, intranasal
  • influenza virus vaccine trivalent
  • inotuzumab
  • isradipine
  • Japanese encephalitis virus vaccine
  • lapatinib
  • leflunomide
  • levofloxacin
  • lofexidine
  • lopinavir
  • maprotiline
  • measles (rubeola) vaccine
  • measles mumps and rubella vaccine, live
  • measles, mumps, rubella and varicella vaccine, live
  • mefloquine
  • meningococcal A C Y and W-135 polysaccharide vaccine combined
  • methadone
  • mifepristone
  • moxifloxacin
  • muromonab CD3
  • mycophenolate
  • nilotinib
  • nortriptyline
  • octreotide
  • ofloxacin
  • olanzapine
  • ondansetron
  • osimertinib
  • paliperidone
  • panobinostat
  • pasireotide
  • pazopanib
  • pentamidine
  • perphenazine
  • pimavanserin
  • pimozide
  • pitolisant
  • pneumococcal vaccine 13-valent
  • pneumococcal vaccine heptavalent
  • pneumococcal vaccine polyvalent
  • posaconazole
  • procainamide
  • propafenone
  • protriptyline
  • quetiapine
  • quinidine
  • quinine
  • rabies vaccine
  • rabies vaccine (chick embryo cell derived)
  • ranolazine
  • remdesivir
  • ribociclib
  • rilonacept
  • rilpivirine
  • risperidone
  • ritonavir
  • romidepsin
  • rotavirus oral vaccine, live
  • rubella vaccine
  • saquinavir
  • sertraline
  • sirolimus
  • smallpox vaccine (live)
  • solifenacin
  • sorafenib
  • sotalol
  • sunitinib
  • tacrolimus
  • telavancin
  • temsirolimus
  • tetanus toxoid adsorbed or fluid
  • tetrabenazine
  • thioridazine
  • thiothixene
  • tick borne encephalitis vaccine
  • tocilizumab
  • tofacitinib
  • tongkat ali
  • toremifene
  • travelers diarrhea and cholera vaccine inactivated
  • trimipramine
  • typhoid polysaccharide vaccine
  • typhoid vaccine live
  • ustekinumab
  • vandetanib
  • vardenafil
  • varicella virus vaccine live
  • vemurafenib
  • vilanterol/fluticasone furoate inhaled
  • voriconazole
  • vorinostat
  • yellow fever vaccine
  • ziprasidone
  • zoster vaccine live

Monitor Closely

  • astragalus
  • cholera vaccine
  • dengue vaccine
  • denosumab
  • echinacea
  • influenza virus vaccine quadrivalent, recombinant
  • influenza virus vaccine trivalent, recombinant
  • maitake
  • mercaptopurine
  • methotrexate
  • osilodrostat
  • ozanimod
  • selpercatinib
  • siponimod
  • sipuleucel-T
  • tobramycin inhaled
  • zoster vaccine recombinant

Minor

  • chloroquine
  • praziquantel

Adverse Effects

Frequency Not Defined

  • Blood and lymphatic system disorders: Bone marrow failure, anemia, aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia; hemolysis reported in individuals with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency
  • Cardiovascular disorders: Cardiomyopathy, QT interval prolongation, and ventricular arrhythmias and torsade de pointes
  • Ear and labyrinth disorders: Vertigo, tinnitus, nystagmus, nerve deafness, deafness
  • Eye disorders: Irreversible retinopathy with retinal pigmentation changes (bull’s eye appearance), visual field defects (paracentral scotomas) and visual disturbances (visual acuity), maculopathies (macular degeneration), decreased dark adaptation, color vision abnormalities, corneal changes (edema and opacities) including corneal deposition of drug with or without accompanying symptoms (halo around lights, photophobia, blurred vision)
  • Gastrointestinal disorders: Nausea, vomiting, diarrhea, abdominal pain
  • Hepatobiliary disorders: Liver function tests abnormal, Acute hepatic failure
  • Immune system disorders: Urticaria, angioedema, bronchospasm
  • Metabolism and nutrition disorders: Decreased appetite, hypoglycemia, porphyria, weight decreased
  • Musculoskeletal and connective tissue disorders: Sensorimotor disorder, skeletal muscle myopathy or neuromyopathy leading to progressive weakness and atrophy of proximal muscle groups, depression of tendon reflexes and abnormal nerve conduction
  • Nervous system disorders: Headache, dizziness, seizure, ataxia and extrapyramidal disorders such as dystonia, dyskinesia, tremor
  • Psychiatric disorders: Affect/emotional lability, nervousness, irritability, nightmares, psychosis, suicidal behaviour
  • Skin and subcutaneous tissue disorders: Rash, pruritus, pigmentation disorders in skin and mucous membranes, hair color changes, alopecia; dermatitis bullous eruptions including erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS syndrome), photosensitivity, dermatitis exfoliative, acute generalized exanthematous pustulosis (AGEP)

Contraindications & Warnings

Contraindicated in

  • Hypersensitivity to HCQ and related components
  • Long-term use in children
  • Retinal or visual field changes due to similar compounds
  • Pre-existing cardiomyopathy and cardiac rhythm disorders
  • G6PD deficiency

Increased risk for

  • QT prolongation
  • Exacerbation of psoriasis
  • Retinal damage
  • Loss of visual acuity
  • Exacerbation of porphyria
  • Dermatitis outbreaks
  • Cardiomyopathy
  • Aplastic anaemia
  • Agranulocytosis
  • Myopathy
  • Suicidal behaviour
  • In patients with cardiovascular disorders
  • In patients with hepatic and renal impairment
  • In concomitant use with antidiabetic agent

Safety Advice

🍺   Alcohol: Caution

🤰🏻   Pregnancy: Category C

🤱🏻   Breastfeeding: Unsafe

🚗   Driving: Unsafe

 Kidney: Caution

 Liver: Caution

 

Pharmacology

Mechanism of Action

  • In Malaria: HCQ interfere with the digestive vacuole function within susceptible malarial parasites by increasing pH and interrupting with the lysosomal degradation of Hb, thereby impeding the normal cell function of sensitive parasites
  • In COVID-19: The antiviral activity of HCQ in COVID-19 might be exerted by changing the pH at the cell membrane surface and inhibiting viral fusion. It can also inhibit nucleic acid replication, glycosylation of viral proteins, as well as viral assembly and release
  • In Rheumatoid arthritis and systemic lupus erythematosus: Mechanisms underlying the anti-inflammatory and immunomodulatory effects of hydroxychloroquine are unknown

Pharmacokinetic

  • Bioavailability: Variable (74% on average); Tmax = 2–4.5 hours
  • Protein binding: 45%
  • Metabolism: Liver
  • Elimination half-life: 32–50 days
  • Excretion: Mostly kidney (23–25% as unchanged drug), also biliary (<10%)

Pharmacodynamics

  • Hydroxychloroquine affects the function of lysozomes in humans as well as plasmodia. 
  • Altering the pH of the lysozomes reduces low affinity self antigen presentation in autoimmue diseases and interferes with the ability of plasmodia to proteolyse hemoglobin for their energy requirements

General Considerations

  • Advise patients to take with food or milk
  • Alcohol must be avoided
  • Toxicity: Patients experiencing an overdose may present with headache, drowsiness, visual disturbances, cardiovascular collapse, convulsions, hypokalemia, rhythm and conduction disorders including QT prolongation, torsades de pointes, ventricular tachycardia, and ventricular fibrillation. This may progress to sudden respiratory and cardiac arrest. Overdose should be treated with immediate gastric lavage and activated charcoal at a dose of at least 5 times the hydroxychloroquine dose within 30 minutes. Parenteral diazepam may be given to treat cardiotoxicity, transfusion may reduce serum concentrations of the drug, patients should be monitored for at least 6 hours, fluids should be given, and ammonium chloride should be given to acidify urine and promote urinary excretion. Patients may also be given epinephrine. Patients with severe toxicity should be intubated and sedated with high doses of benzodiazepines, and circulatory support should be provided with fluids and vasopressors (e.g. epinephrine). Consider early intravenous lipid therapy for patients with ventricular dysrhythmias or hypotension. Orotracheal intubation for airway protection should be performed early in cases of severe psychomotor agitation, repeated seizure activity, coma, or evidence of severe quinidine-like cardiotoxicity

General Monitoring Parameters

  • ECG for estimation of QT interval
  • CBC at baseline with periodic tests for liver function, renal function, blood glucose level, and muscle strength during long-term therapy 
  • Ophthalmologic examination

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