What is Hydroxychloroquine Sulfate?

Hydroxychloroquine sulfate is a tablet used mainly to prevent and treat malaria. It is also used to treat autoimmune diseases such as lupus and rheumatoid arthritis (RA).

It belongs to a class of drugs called disease-modifying antirheumatic drugs (DMARDs). It has a structural relationship with chloroquine, which serves as a treatment for malaria.

Hydroxychloroquine is also popularly known for its immunomodulatory effect. It excels in diseases such as lupus and RA, where the body’s immune system attacks the body’s tissues.

Uses of Hydroxychloroquine

Hydroxychloroquine sulfate is applied beyond the treatment of malaria. Hydroxychloroquine also provides relief for autoimmune diseases by fighting inflammation and enhancing symptoms.

Its most widespread applications are:

Hydroxychloroquine is used to prevent and treat malaria, especially from Plasmodium species. It may do so by changing how the parasite metabolizes hemoglobin.

This is at the very core. It is useful where chloroquine-resistant malaria is present. There is also some resistance to hydroxychloroquine.

People with systemic lupus erythematosus (SLE) and rheumatoid arthritis are most likely to use it. When someone has an autoimmune disease, their immune system strikes healthy tissue by accident.

It causes inflammation, pain, and harm to organs. Hydroxychloroquine alleviates symptoms including weariness, joint discomfort, and skin rashes.

It does so by regulating the way the immune system reacts and reduces inflammation.

Researchers looked at hydroxychloroquine early in the COVID-19 pandemic as a treatment. Clinical trials have shown mixed results. So, routine treatment of COVID-19 is not advisable.

Benefits

Doctors employ hydroxychloroquine to treat malaria caused by Plasmodium species. It prevents individuals from traveling to malaria-endemic regions and those infected with malaria.

Hydroxychloroquine alleviates symptoms of autoimmune illnesses such as lupus and rheumatoid arthritis.

It prevents flares and improves the quality of life in patients. Its immunomodulatory effect reduces inflammation and tissue damage in autoimmune diseases.

Anti-inflammatory Effect: It alleviates pain and inflammation, particularly in autoimmune diseases. This makes it significant for the long-term treatment of these diseases.

How Does It Work?

Hydroxychloroquine stops the Plasmodium parasite from breaking down hemoglobin. This process is crucial for the parasite’s growth and survival in malaria.

Disrupting this process prevents the parasite from replicating in red blood cells. In conditions like lupus and rheumatoid arthritis, hydroxychloroquine regulates the immune system.

Hydroxychloroquine stops T lymphocytes from working. These immune cells help with inflammation and immunity. 

Hydroxychloroquine raises cell pH levels, especially in lysosomes and acidic parts of immune cells.

It hurts their ability to break down proteins and antigens. It also struggles to manage immune function and control inflammation.

It is strongest against Plasmodium ovale, Plasmodium vivax, and Plasmodium falciparum. Hydroxychloroquine stops the malaria parasite from growing in red blood cells.

It does this by interfering with the parasite’s metabolism. Start using prophylactics weeks before potential exposure. Keep using them for weeks after leaving the affected area.

Rheumatoid Arthritis (RA): RA is an autoimmune disease. When the immune system attacks the joints, it causes swelling, pain, and disability.

Doctors use hydroxychloroquine to relieve signs like joint pain and stiffness. You will see improvement after weeks or even months, but it stops permanent joint damage.

Lupus (SLE): Lupus is an autoimmune disorder. In this condition, the immune system attacks different organs. These can include the kidneys, skin, and heart.

Hydroxychloroquine lowers lupus symptoms. These symptoms include skin rashes, fatigue, and joint pain.

Dosage Guidelines

The treatment of the condition requires a different dosage of hydroxychloroquine sulfate. General guidelines for various conditions are as follows:

A medical professional must instruct you to take hydroxychloroquine sulfate. It is usually administered in tablet form. Take the tablets whole with water.

Taking them with food is best to keep your stomach from getting upset. Taking the right dose will help the drug work better and reduce side effects.

Initial Dose: The doctor prescribes a larger first dose based on the condition to treat. For instance, in malaria, the dose may be 800 mg as the initial dose and then 400 mg at intervals.

Maintenance Dose: After starting treatment, the maintenance dose is usually lower. For chronic diseases like RA and lupus, it is 200-400 mg daily.

Hydroxychloroquine sulfate must be avoided in patients who:

Are allergic to hydroxychloroquine or chloroquine.

Have existing retinal or macula damage as the drug accelerates vision loss.

Avoid this drug if you have severe kidney or liver disease. The liver processes it, and the kidneys remove it.

Drug Interactions

Hydroxychloroquine sulfate interacts with a broad category of drugs. Some of the reported interactions include:

Aluminum or magnesium antacids may cut down the absorption of hydroxychloroquine in the stomach and intestines.

Hydroxychloroquine can increase digoxin levels in the blood. This raises the risk of toxicity from this heart disease medicine.

Using other antimalarial drugs with hydroxychloroquine can raise the risk of side effects. This includes toxicity.

Before taking it with other medicines, it’s best to talk to a doctor or nurse. This helps avoid any unwanted interactions.

Cisplatin is an anticancer drug. It may increase the risk of retinal toxicity if used with hydroxychloroquine.

Quinidine increases the risk of arrhythmias when taken with hydroxychloroquine.

Safety Advice

Regular Eye Checkups: Hydroxychloroquine can harm the retina. So, regular eye checkups are important, especially if you use it long-term.

Monitoring Side Effects: Headache, dizziness, nausea, and rash are typical side effects. If you notice severe side effects, like vision changes or heart problems, see a doctor right away.

Concerns

Long-term Use: Taking hydroxychloroquine for a long time can lead to retinal toxicity. This may result in lasting vision loss. Regular ocular examinations must be undertaken.

Pregnancy: Doctors call Hydroxychloroquine a class C drug. They should only utilize it when required. Using treatments for illnesses such as lupus is not harmful, but experts say caution.

Precautions

Take care when using hydroxychloroquine if you have liver or kidney disease. The liver processes this drug, and the kidneys help get rid of it.

If you have a blood disorder, such as G6PD deficiency, talk to your doctor before using hydroxychloroquine.

Warnings

Cardiac Effects: Hydroxychloroquine can cause heart issues like arrhythmias. This risk is higher for patients with existing heart disease.

Neurological Side Effects: At high doses, hydroxychloroquine may lead to confusion or seizures.

What Else Can I Do to Help My Condition?

Besides medication, patients are advised to adopt the following lifestyle modifications:

Special Dietary and Lifestyle Recommendations

Comparison with Other Treatments

Researchers think hydroxychloroquine has fewer side effects than chloroquine, especially when used long-term.

It is unlikely to pose significant toxicity to the retina. So, it is the preferred drug for autoimmune diseases. Methotrexate (for RA) is a stronger immunosuppressant than hydroxychloroquine.

It is usually saved for cases where hydroxychloroquine doesn’t work. Methotrexate can cause serious side effects like liver damage and lung disease.

So, hydroxychloroquine is a safer option for some patients.

What Not to Do

Avoid discontinuing treatment without warning. Halting hydroxychloroquine can make symptoms worse, especially for autoimmune diseases.

Take the dose prescribed. Taking more hydroxychloroquine can lead to harmful side effects. These include heart problems, seizures, or even death.