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(KLOR-oh-kwin)
Chloroquine Phosphate
Aralen Phosphate
Chloroquine Hydrochloride
Aralen HCl
Class: Anti-infective/antimalarial

 Action Inhibits parasite growth, possibly by concentrating within parasite acid vesicles, raising pH.

 Indications Prophylaxis and treatment of acute attacks of malaria caused by Plasmodium vivax, P malariae, P ovale and susceptible strains of P falciparum; extraintestinal amebiasis. Unlabeled use(s): Treatment of rheumatoid arthritis, systemic and discoid lupus erythematosus, porphyria cutanea tarda, scleroderma, pemphigus, lichen planus, polymyositis and sarcoidosis.

 Contraindications Retinal or visual field changes.

 Route/Dosage

Doses are listed in base equivalents. (Chloroquine phosphate, 500 mg equals 300 mg base; chloroquine hydrochloride, 50 mg equals 40 mg base.)

Acute Malaria

CHLOROQUINE PHOSPHATE: ADULTS: Initial dose: PO 600 mg, then 300 mg 6 hr later and 300 mg qd for 2 days. CHILDREN: Initial dose: PO 10 mg/kg, then 5 mg/kg 6 hr later and 5 mg/kg qd for 2 days. CHLOROQUINE HYDROCHLORIDE: ADULTS: INITIAL DOSE: IM 160–200 mg then repeat dose in 6 hr if needed (maximum 800 mg base total dose in first 24 hr). CHILDREN: 5 mg/kg/dose; repeat dose in 6 hr (maximum 10 mg base/kg/24 hr; do not exceed 5 mg/kg as single parenteral dose).

Malaria Suppression

ADULTS: PO 300 mg base. CHILDREN: 5 mg/kg/dose (maximum 300 mg base) weekly. Begin 1–2 wk prior to exposure and continue for 4 wk after leaving endemic area. If suppressive therapy is not begun prior to exposure, double initial loading dose and give in 2 divided doses 6 hr apart.

Extraintestinal Amebiasis

CHLOROQUINE PHOSPHATE: ADULTS: PO 600 mg base/day for 2 days, then 300 mg base/day for 2–3 wk. CHLOROQUINE HYDROCHLORIDE: ADULTS: IM 4–5 ml (160–200 mg base)/day for 10–12 days.

 Interactions

Cimetidine: May increase chloroquine serum concentration. Kaolin aluminum or magnesium trisilicate antacids: May decrease GI absorption of chloroquine. Rabies vaccine: Concomitant administration of intradermally administered rabies vaccine and chloroquine may result in diminished antibody response to vaccine. In this situation CDC recommends administering rabies vaccine intramuscularly.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Hypotension; ECG changes. CNS: Headache; neuropathy; seizures; psychotic episodes. DERM: Pruritus; pigment changes; skin eruptions. EENT: Visual disturbances; retinal damage and deafness with prolonged high-dose use; tinnitus. GI: Anorexia; nausea; vomiting; diarrhea; abdominal cramps. HEMA: Agranulocytosis; blood dyscrasias; aplastic anemia. HEPA: Hepatitis. OTHER: Muscle weakness.

 Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: Especially sensitive to adverse effects; do not exceed recommended dose. G-6-PD deficiency: May induce hemolysis in presence of infection or stressful condition. Muscular weakness: May need to discontinue therapy if muscle weakness occurs. Psoriasis or porphyria: May be exacerbated. Retinopathy: Irreversible retinal damage has occurred. Special risk patients: Monitor patients with hepatic disease or alcoholism or taking other hepatotoxic medications for evidence of worsening liver function such as bleeding.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer with food or milk.
  • If taken once weekly, take on same day of week.
  • Store in airtight, light-resistant container at room temperature.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Review history for blood disorders, eye or vision problems, G-6-PD deficiency, liver disease, alcoholism, porphyria or psoriasis.
  • Arrange for a complete eye examination to establish baseline values.
  • Perform baseline assessment for signs and symptoms of infection.
  • Provide small, frequent meals if GI distress occurs.
  • Arrange for and monitor periodic CBCs.
  • If sore throat, fever, weakness, fatigue, unusual bleeding or bruising occurs, notify physician.
  • Perform periodic neuromuscular examinations, and notify patient if knee and ankle reflexes are weak.

OVERDOSAGE: SIGNS & SYMPTOMS
  Headache, drowsiness, visual disturbances, cardiovascular collapse, seizures, respiratory and cardiac arrest, death

 Patient/Family Education

  • Remind patient to take medication with food to minimize GI irritation.
  • Stress importance of compliance with full course of therapy. If used for suppression, drug must be taken at least 1 wk before entering and for 4 wk after leaving endemic area.
  • Caution patient to drink alcoholic beverages sparingly because of increased GI irritation and higher risk of liver damage.
  • Stress importance of eye examinations q 3–6 mon during prolonged daily therapy.
  • Inform patient that drug may cause rusty or brown discoloration of urine.
  • Advise use of dark glasses in bright light to reduce risk of ocular damage.
  • Instruct patient to report these symptoms to physician: blurring or change in vision, buzzing or difficulty hearing, muscle weakness, rash, vomiting or stomach pain, difficulty breathing or swallowing.

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