Class: Antimalarials
VA Class: AP101
CAS Number: 50-63-5
Brands: Aralen Phosphate
Introduction
Antimalarial; 4-aminoquinoline derivative.136
Uses for Chloroquine Phosphate
Malaria
Prevention (prophylaxis) of malaria caused by Plasmodium malariae, P. ovale, chloroquine-susceptible P. vivax, or chloroquine-susceptible P. falciparum.136 174 176 178 Recommended by CDC and others as drug of choice for prevention of malaria caused by susceptible Plasmodium; should be used whenever malaria prophylaxis is indicated in individuals traveling to malarious areas where chloroquine-resistant P. falciparum malaria has not been reported.140 147 148 149 162 163 164 166 174 175 176 177 178 (See Chloroquine-resistant Plasmodium under Cautions.)
Treatment of uncomplicated malaria caused by susceptible P. falciparum.191 Recommended by CDC and others as the drug of choice for treatment of uncomplicated P. falciparum malaria acquired in areas where chloroquine resistance has not been reported.174 183 191 (See Chloroquine-resistant Plasmodium under Cautions.)
Treatment of uncomplicated malaria caused by P. malariae, P. ovale, or chloroquine-susceptible P. vivax.136 174 183 191 Recommended by CDC and others as the drug of choice for treatment of uncomplicated malaria caused by these Plasmodium;174 183 191 do not use for P. vivax malaria acquired in Papua New Guinea or Indonesia.183 191 (See Chloroquine-resistant Plasmodium under Cautions.)
Active only against the asexual erythrocytic forms of Plasmodium (not exoerythrocytic stages) and cannot prevent delayed primary attacks or relapse of P. ovale or P. vivax malaria or provide a radical cure; primaquine usually also indicated to eradicate hypnozoites and prevent relapse in patients exposed to or being treated for P. ovale or P. vivax malaria.176 183
Detailed recommendations regarding prevention of malaria available from CDC 24 hours a day from the voice information service (877-394-8747) or at .176
Assistance with diagnosis or treatment of malaria available from CDC Malaria Hotline at 770-488-7788 from 8:00 a.m. to 4:30 p.m. Eastern Standard Time or CDC Emergency Operation Center at 770-488-7100 after hours, on weekends, and holidays.191
Extraintestinal Amebiasis
Has been used for treatment of extraintestinal amebiasis136 (including liver abscess) caused by Entamoeba histolytica.
Ineffective for treatment of intestinal amebiasis.a
A nitroimidazole derivative (metronidazole, tinidazole) followed by a luminal amebicide (iodoquinol, paromomycin, diloxanide furoate) is usual regimen of choice for mild to moderate or severe intestinal disease and for amebic hepatic abscess.174 178
Rheumatoid Arthritis
Has been used for treatment of rheumatoid arthritis† in patients whose symptoms progress despite an adequate regimen of nonsteroidal anti-inflammatory agents (NSAIAs).a
No longer a recommended disease-modifying antirheumatic drug (DMARD).a Other DMARDs generally preferred,105 106 especially since risk of severe and sometimes irreversible toxicity must be considered if chloroquine is used for prolonged periods in treatment of rheumatoid arthritis. (See Cautions.)a
Lupus Erythematosus
Has been used as an adjunct to topical corticosteroid therapy in treatment of discoid lupus erythematosus† and as an adjunct to systemic corticosteroid and/or salicylate therapy in treatment of systemic lupus erythematosus†.a
If used for prolonged periods in the treatment of lupus erythematosus, the risk of serious and sometimes irreversible toxicity should be considered.a (See Cautions.)
Porphyria Cutanea Tarda and Polymorphous Light Eruptions
Has been used with some success in treatment of porphyria cutanea tarda†.185 186 187 (See Patients with Psoriasis or Porphyria under Cautions.)
Has been effective in some cases when used in treatment of polymorphous light eruptions†.
Sarcoidosis
Has been used with some success in the treatment of sarcoidosis†.188 189
Chloroquine Phosphate Dosage and Administration
Administration
Administer orally.136
Oral Administration
Administration with meals may minimize adverse GI effects.a
Because tablets have a bitter taste, they have been pulverized and mixed with chocolate or cherry syrup for administration in children or, alternatively, enclosed in gelatin capsules for mixing in food or drink.a Outside the US, the drug is available in many countries as an oral suspension for use in children.176 However, the chloroquine concentration varies depending on the specific oral suspension, and parents should be instructed how to calculate the appropriate volume to be administered based on the child's body weight.176
For prevention of malaria, chloroquine is given once weekly and should be administered on the same day each week.136 148 163 166 If intolerable adverse GI effects occur despite administration with meals, the usual weekly dose can be divided into 2 doses and administered on separate days during the week.a
Dosage
Available as chloroquine phosphate;136 dosage usually expressed in terms of chloroquine.136 Each 100 mg of chloroquine phosphate is equivalent to 60 mg of chloroquine.136
Dosage of chloroquine in children should be calculated in proportion to adult dosage based on body weight.136
Pediatric Patients
Malaria
Prevention of Malaria in Areas without Chloroquine-resistant Plasmodium
Oral
5 mg/kg (8.3 mg/kg of chloroquine phosphate) once weekly on the same day each week.136 163 174 176
Initiate prophylaxis 1–2 weeks prior to entering a malarious area and continue for 4 weeks after leaving the area.176
Terminal prophylaxis with primaquine may be indicated during the final 2 weeks of chloroquine prophylaxis if exposure occurred in areas where P. ovale or P. vivax are endemic.174 176
Treatment of Uncomplicated Chloroquine-susceptible Malaria
Oral
An initial dose of 10 mg/kg of chloroquine (16.7 mg/kg of chloroquine phosphate) followed by 5-mg/kg doses (8.3 mg/kg of chloroquine phosphate) given at 6, 24, and 48 hours after the initial dose.174 183 191
Adults
Malaria
Prevention of Malaria in Areas without Chloroquine-resistant Plasmodium
Oral
300 mg (500 mg of chloroquine phosphate) once weekly.136 163 174 176
Initiate prophylaxis 1–2 weeks prior to entering a malarious area and continue for 4 weeks after leaving the area.176
Terminal prophylaxis with primaquine may be indicated during the final 2 weeks of chloroquine prophylaxis if exposure occurred in areas where P. ovale or P. vivax are endemic.174 176
Treatment of Uncomplicated Chloroquine-susceptible Malaria
Oral
An initial dose of 600 mg of chloroquine (1 g of chloroquine phosphate) followed by 300-mg doses (500 mg of chloroquine phosphate) given at 6, 24, and 48 hours after the initial dose.191
Prophylaxis of P. ovale or P. vivax When Primaquine Is Deferred during Pregnancy
Oral
300 mg (500 mg of chloroquine phosphate) once weekly for the duration of the pregnancy.183 Given after the usual treatment regimen and continued until primaquine can be given to provide a radical cure after delivery.183
Extraintestinal Amebiasis
Oral
600 mg of chloroquine (1 g of chloroquine phosphate) once daily for 2 days, followed by 300 mg (500 mg of chloroquine phosphate) once daily for at least 2–3 weeks; usually used in conjunction with an intestinal amebicide.136
Rheumatoid Arthritis†
Oral
150 mg (250 mg of chloroquine phosphate) daily. After remission or maximum improvement occurs, dosage should be reduced.a
A response may not occur until after >4–6 weeks of therapy.a Some clinicians recommend that the drug be continued for 4 months before being considered ineffective for treatment of rheumatoid arthritis.a
Lupus Erythematosus†
Oral
150 mg (250 mg of chloroquine phosphate) daily.a
When used in conjunction with topical corticosteroids in treatment of discoid lupus erythematosus, skin lesions may regress within 3–4 weeks and new lesions may not appear.a When systemic and cutaneous manifestations of lupus erythematosus subside, reduce chloroquine dosage gradually over several months, and discontinue as soon as possible.a
Prescribing Limits
Pediatric Patients
Malaria
Prevention of Malaria in Areas Without Chloroquine-resistant Plasmodium
Oral
Maximum dosage of 300 mg (500 mg of chloroquine phosphate) daily, regardless of weight.136 174 176
Cautions for Chloroquine Phosphate
Contraindications
Hypersensitivity to chloroquine or other 4-aminoquinoline derivatives.136
Retinal or visual field changes attributable to 4-aminoquinoline derivatives or to any other etiology.136 After weighing the possible benefits and risks to the patient, some clinicians may elect to use chloroquine in these patients for treatment of acute attacks of malaria caused by susceptible Plasmodium.136
Warnings/Precautions
Warnings
Chloroquine-resistant Plasmodium
For prevention of malaria, use only in individuals traveling to malarious areas where chloroquine-resistant P. falciparum malaria has not been reported.136 140 147 148 149 162 163 164 166 174 175 176 177 178 Malaria-related deaths have been reported in US citizens using chloroquine-containing regimens (i.e., chloroquine alone or in conjunction with proguanil) for malaria prevention in countries with chloroquine-resistant P. falciparum.118
For prevention or treatment of malaria, consider that chloroquine-resistant P. falciparum have been reported in many areas where malaria occurs.140 143 144 174 176 183
Consider that chloroquine-resistant P. vivax has been reported with a high incidence in Papua New Guinea and Indonesia and rarely in Burma (Myanmar), India, and Central and South America.183 191 A treatment regimen effective against chloroquine-resistant P. vivax should be used in those who acquire P. vivax malaria in Papua New Guinea or Indonesia.174 183 191
Malaria patients who do not respond to chloroquine should be switched to a treatment recommended for chloroquine-resistant P. falciparum (e.g., quinine sulfate with doxycycline, tetracycline or clindamycin; fixed combination of atovaquone and proguanil; fixed combination of artemether and lumefantrine) or chloroquine-resistant P. vivax (e.g., quinine sulfate with doxycycline or tetracycline in conjunction with primaquine; mefloquine in conjunction with primaquine; fixed combination of atovaquone and proguanil in conjunction with primaquine).183 191
Ocular Effects
Dose-related retinopathy reported, which may progress even after the drug is discontinued.136 Retinal changes may be reversible if detected early, but usually are permanent and may rarely result in blindness.136
Whenever long-term therapy is contemplated, perform initial (base line) and periodic ophthalmologic examinations, including visual acuity, slit-lamp, funduscopic, and visual field tests.136
Discontinue drug immediately and closely observe patient for possible progression if there is any indication of abnormalities in visual acuity or visual field, abnormalities in the retinal macular area (such as pigmentary changes or loss of foveal reflex), or if any other visual symptoms (e.g., light flashes and streaks) occur which are not fully explainable by difficulties of accommodation or corneal opacities.136
Neuromuscular Effects
Skeletal muscle myopathy or neuromyopathy occur rarely; neuromyopathy is manifested as slowly progressing weakness which first affects proximal muscles of lower extremities.136
Patients receiving prolonged therapy should be questioned and examined periodically for evidence of muscular weakness; knee and ankle reflexes should be tested.136
Discontinue chloroquine if muscular weakness occurs.136
Patients with Psoriasis or Porphyria
May exacerbate psoriasis and precipitate a severe attack in patients with the disease.136 Use in psoriasis patients only if potential benefits outweigh the risks.136
May exacerbate porphyria.136 Use in patients with porphyria only if potential benefits outweigh the risks.136
General Precautions
Hematologic Effects
Aplastic anemia, reversible agranulocytosis, thrombocytopenia, and neutropenia reported rarely.136
Periodically monitor CBCs in patients receiving prolonged treatment.136 Consider discontinuing chloroquine if any severe blood disorder occurs which is not attributable to the disease being treated.136
Use with caution in patients with G-6-PD deficiency.136
Otic Effects
Nerve-type deafness, tinnitus, and reduced hearing reported rarely in patients with pre-existing auditory damage.136
Use with caution in patients with preexisting auditory damage.136 Discontinue chloroquine immediately and closely observe patient if any hearing defects occur.136
CNS Effects
Seizures may occur; advise patients with a history of epilepsy about the risk.136
Specific Populations
Pregnancy
Category C.c
Avoid use during pregnancy unless the clinician determines that the benefits of prevention or treatment of malaria outweigh the risks.136
Has been used for prophylaxis and treatment of malaria in pregnant women without evidence of adverse effects on the fetus.176
CDC states that the benefits of chloroquine prophylaxis in pregnant women exposed to malaria outweigh the potential risks to the fetus.176
Because malaria infection in pregnant women is associated with high risks of maternal and perinatal morbidity and mortality (e.g., miscarriage, premature delivery, low birth weight, congenital infection and/or perinatal death), CDC recommends prompt chloroquine treatment in pregnant women with uncomplicated malaria caused by P. malariae, P. ovale, chloroquine-susceptible P. falciparum, or chloroquine-susceptible P. vivax.183
Because use of primaquine should be deferred during pregnancy, CDC recommends that pregnant women being treated for P. ovale or P. vivax malaria receive chloroquine prophylaxis for the duration of the pregnancy (after the initial chloroquine treatment regimen) until primaquine can be given after delivery to provide a radical cure.183 191
Lactation
Distributed into milk.122 123 124 Discontinue nursing or the drug.136
Amount of drug present in human milk does not appear to be harmful to nursing infants, but is insufficient to provide adequate protection against malaria in these infants.176 When chemoprophylaxis is necessary in such infants, they should receive recommended dosages of the appropriate antimalarial agent(s).176
Pediatric Use
Pediatric patients are especially sensitive to 4-aminoquinoline derivatives.136 Fatalities have been reported following accidental ingestion of relatively small doses.136
Geriatric Use
Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.136
Substantially eliminated by kidneys; risk of toxicity may be greater in patients with impaired renal function.136 Select dosage with caution and assess renal function periodically since geriatric patients are more likely to have renal impairment.136
Hepatic Impairment
Concentrates in the liver; use with caution in patients with hepatic disease or alcoholism and in those receiving known hepatotoxic drugs.136
Common Adverse Effects
Ocular effects; skeletal muscle myopathy or neuromyopathy; GI effects (anorexia, nausea, vomiting, diarrhea, abdominal cramps); dermatologic effects (pleomorphic skin eruptions, skin and mucosal pigmentary changes).136
Interactions for Chloroquine Phosphate
Specific Drugs
Drug
|
Interaction
|
Comments
|
|---|
Ampicillin
|
Possible reduced bioavailability of ampicillin136
|
Administer chloroquine at least 2 hours before or after ampicillin136
|
Antacids
|
Possible reduced GI absorption of chloroquine136
|
Administer chloroquine at least 4 hours before or after antacids136
|
Cimetidine
|
Possible inhibition of chloroquine metabolism resulting in increased concentrations of the antimalarial136
|
Avoid concomitant use136
|
Cyclosporine
|
Possible increased cyclosporine concentrations136
|
Closely monitor serum cyclosporine concentrations; if necessary, discontinue chloroquine136
|
Praziquantel
|
Possible decreased praziquantel concentrations184
|
|
Rabies vaccine
|
Possible interference with immune response to intradermally administered human diploid-cell rabies vaccine (HDCV) (no longer commercially available in the US)116 117 176 182
|
Complete preexposure intradermal vaccination with HDCV (no longer commercially available in the US) before initiating chloroquine malaria prophylaxis or administer the vaccine IM in those receiving chloroquine 176 182
|
Sulfadoxine and pyrimethamine
|
Possible increased incidence and severity of adverse effects when used concomitantly with chloroquine compared with use of sulfadoxine and pyrimethamine alone190
|
|
Chloroquine Phosphate Pharmacokinetics
Absorption
Bioavailability
Rapidly and almost completely absorbed from GI tract following oral administration;a 136 peak plasma concentrations generally attained within 1–2 hours.a
Food
Bioavailability of chloroquine is greater when administered with food;a rate of absorption is unaffected but peak plasma concentrations and AUCs are higher.a
Distribution
Extent
Widely distributed into body tissues.a
Chloroquine binds to melanin-containing cells in the eyes and skin; skin concentrations of the drug are considerably higher than plasma concentrations.a Also concentrates in erythrocytes and binds to platelets and granulocytes.a
Crosses placenta in mice.136 Distributed into milk.122 123 124
Plasma Protein Binding
50–65%.104
Elimination
Metabolism
Partially metabolized; the major metabolite is desethylchloroquine.122 123 124 136 147 Desethylchloroquine also has antiplasmodial activity, but is slightly less active than chloroquine.114
Elimination Route
Chloroquine and its metabolites are slowly excreted by the kidneys; unabsorbed drug is excreted in feces.a
Up to 70% of a dose is excreted unchanged in urine and up to 25% of dose may be excreted in urine as desethylchloroquine.a Small amounts of chloroquine may be present in urine for weeks, months, and occasionally years after the drug is discontinued.a
Half-life
Usually 72–120 hours.a
Serum concentrations decline in a biphasic manner and terminal half-life increases with increasing doses.a Terminal half-life is 3.1 hours after a single 250-mg oral dose, 42.9 hours after a single 500-mg oral dose, and 312 hours after a single 1-g oral dose.a
Stability
Storage
Oral
Tablets
25°C (may be exposed to 15–30°C) in tight container.136
Actions and SpectrumActions
A blood schizonticidal agent active against asexual erythrocytic forms of most strains of Plasmodium malariae, P. ovale, P. vivax, and many strains of P. falciparum.a Not active against preerythrocytic or exoerythrocytic forms of plasmodia.a Gametocytocidal for P. malariae and P. vivax, but has no direct activity against the gametocytes of P. falciparum.a
Chloroquine-resistant P. falciparum also are resistant to hydroxychloroquine and may be cross-resistant to pyrimethamine or quinine.a Chloroquine-resistant P. falciparum may be susceptible to quinine or the fixed combination of sulfadoxine and pyrimethamine, but P. falciparum resistant to both chloroquine and sulfadoxine and pyrimethamine are widespread in certain areas.176
Active in vitro against the trophozoite form of Entamoeba histolytica.a Acts as a tissue amebicide.a
Has anti-inflammatory activity; mechanism(s) of action in the treatment of rheumatoid arthritis and lupus erythematosus has not been determined.a
Advice to Patients
Importance of keeping chloroquine out of reach of children since they are especially sensitive to 4-aminoquinoline derivatives.136
Advise patients with a history of epilepsy about the risk of seizures.136
Necessity of taking protective measures to reduce contact with mosquitoes (protective clothing, insect repellents, mosquito nets, remaining in air-conditioned or well-screened areas).140 162 163 164 165 166 176
Possibility of contracting malaria during travel, regardless of prophylactic regimen used.140 162 163 164 165 166 176
Importance of seeking medical attention as soon as possible if febrile illness develops during or after return from a malaria-endemic area and of informing clinician of possible malaria exposure.162 163 166 176
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.136
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.136
Importance of informing patients of other important precautionary information. (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Chloroquine Phosphate
Routes
|
Dosage Forms
|
Strengths
|
Brand Names
|
Manufacturer
|
|---|
Oral
|
Tablets, film-coated
|
150 mg (of chloroquine)*
|
Chloroquine Phosphate Tablets
|
Global, West-Ward
|
|
|
300 mg (of chloroquine)*
|
Aralen Phosphate
|
Sanofi-Aventis
|
|
|
|
Chloroquine Phosphate Tablets
|
West-Ward
|
Comparative Pricing
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Aralen 500MG Tablets (SANOFI-AVENTIS U.S.): 25/$190 or 75/$545.96
Chloroquine Phosphate 250MG Tablets (WEST-WARD): 30/$70.99 or 90/$203.98
Chloroquine Phosphate 500MG Tablets (WEST-WARD): 7/$36.99 or 21/$108.97
Disclaimer
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions January 2010. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
† Use is not currently included in the labeling approved by the US Food and Drug Administration.
References
Only references cited for selected revisions after 1984 are available electronically.
101. Trigg PI, Wensdorfer WH, Sheth UK et al. Intramuscular chloroquine in children. Lancet. 1984; 2:288. [IDIS 188799] [PubMed 6146836]
104. White NJ. Clinical pharmacokinetics of antimalarial drugs. Clin Pharmacokinet. 1985; 10:187-215. [IDIS 202191] [PubMed 3893840]
105. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum. 2002; 46:328-46. [IDIS 476480] [PubMed 11840435]
106. Anon. Drugs for rheumatoid arthritis. Med Lett Drugs Ther. 2000; 42:57-64. [PubMed 10887424]
107. Chow AW, Jewesson PJ. Pharmacokinetics and safety of antimicrobial agents during pregnancy. Rev Infect Dis. 1985; 7:287-313. [IDIS 200121] [PubMed 3895351]
108. Public Health Laboratory Service Malaria Reference Laboratory. Prevention of malaria in pregnancy and early childhood. BMJ. 1984; 289:1296-7. [IDIS 192762] [PubMed 6437523]
109. Wolfe MS, Cordero JF. Safety of chloroquine in chemosuppression of malaria during pregnancy. BMJ. 1985; 290:1466-7. [IDIS 201367] [PubMed 3922534]
114. Verdier F, LeBras J, Clavier F et al. Blood levels and in vitro activity of desethylchloroquine against Plasmodium falciparum. Lancet. 1984; 1:1186-7. [IDIS 185836] [PubMed 6144914]
115. Akintonwa A, Odutola TA, Edeki T et al. Hemodialysis clearance of chloroquine in uremic patients. Ther Drug Monit. 1986; 8:285-7. [IDIS 220380] [PubMed 3750371]
116. Taylor DN, Wasi C, Bernard K. Chloroquine prophylaxis associated with a poor antibody response to human diploid cell rabies vaccine. Lancet. 1984; 1:1405. [IDIS 186824] [PubMed 6145850]
117. Pappaioanou M, Fishbein DB, Dreesen DW et al. Antibody response to preexposure human diploid-cell rabies vaccine given concurrently with chloroquine. N Engl J Med. 1986; 314:280-4. [IDIS 209991] [PubMed 3510393]
118. Centers for Disease Control and Prevention. Malaria deaths following inappropriate malaria chemoprophylaxis—United States, 2001. MMWR Morb Mortal Wkly Rep. 2001; 50:597-9. [PubMed 11476528]
119. Ratliff NB, Estes ML, Myles JL et al. Diagnosis of chloroquine cardiomyopathy by endomyocardial biopsy. N Engl J Med. 1987; 316:191-3. [IDIS 224846] [PubMed 3796692]
120. Piette JC, Guillevin L, Chapelon C et al. Chloroquine cardiotoxicity. N Engl J Med. 1987; 317:710-1. [IDIS 233346] [PubMed 3627179]
121. Centers for Disease Control and Prevention. Local transmission of Plasmodium vivax malaria—Virginia, 2002. MMWR Morb Mortal Wkly Rep. 2002; 51:921-3. [IDIS 488503] [PubMed 12403407]
122. Edstein MD, Veenendaal JR, Newman K et al. Excretion of chloroquine, dapsone and pyrimethamine in human milk. Br J Clin Pharmacol. 1986; 22:733-5. [IDIS 224280] [PubMed 3567020]
123. Ogunbona FA, Onyeji CO, Bolaji OO et al. Excretion of chloroquine and desethylchloroquine in human milk. Br J Clin Pharmacol. 1987; 23:473-6. [IDIS 228665] [PubMed 3580253]
124. Ette EI, Essien EE, Ogonor JI et al. Chloroquine in human milk. J Clin Pharmacol. 1987; 27:499-502. [IDIS 233119] [PubMed 3655001]
125. Jaeger A, Saunder P, Kopferschmitt J et al. Clinical features and management of poisoning due to antimalarial drugs. Med Toxicol Adverse Drug Exp. 1987; 2:242-73. [IDIS 233506] [PubMed 3306266]
126. Ellenhorn MJ, Barceloux DG. Medical toxicology: diagnosis and treatment of human poisoning. New York: Elsevier; 1988:341-7.
127. Riou B, Barriot P, Rimailho A et al. Treatment of severe chloroquine poisoning. N Engl J Med. 1988; 318:1-6. [IDIS 236482] [PubMed 3336379]
133. Krogstad DJ, Herwaldt BL. Chemoprophylaxis and treatment of malaria. N Engl J Med. 1988; 319:1538-40. [IDIS 248326] [PubMed 3185677]
134. White NJ, Miller KD, Churchill FC et al. Chloroquine treatment of severe malaria in children: pharmacokinetics, toxicity, and new dosage recommendations. N Engl J Med. 1988; 319:1493-500. [IDIS 248321] [PubMed 3054558]
136. Sanofi-Synthelabo. Aralen (chloroquine phosphate) prescribing information. New York, NY; 2003 Jun.
140. Anon. Advice for travelers. Med Lett Treat Guid. 2006; 45:25-34.
142. Centers for Disease Control. Revised dosing regimen for malaria prophylaxis with mefloquine. MMWR Morb Mortal Wkly Rep. 1990; 39:630.
143. Whitby M, Wood G, Veenendaal JR et al. Chloroquine-resistant Plasmodium vivax. Lancet. 1989; 2:1395. [IDIS 261420] [PubMed 2574333]
144. World Health Organization. WHO Drug Information. 1990; 4:9-15.
147. Panisko DM, Keystone JS. Treatment of malaria: 1990. Drugs. 1990; 39:160-89. [PubMed 2183998]
148. White NJ. Drug treatment and prevention of malaria. Eur J Clin Pharmacol. 1988; 34:1-14. [IDIS 242316] [PubMed 3282892]
149. White NJ. Antiparasitic drugs in children. Clin Pharmacokinet. 1989; 17(Suppl 1):138-55. [PubMed 2692937]
151. Centers for Disease Control. Change of dosing regimen for malaria prophylaxis with mefloquine. MMWR Morb Mortal Wkly Rep. 1991; 40:72-3. [IDIS 277075] [PubMed 1898981]
152. Anon. Treatment of severe Plasmodium falciparum malaria with quinidine gluconate: discontinuation of parenteral quinine from CDC drug service. MMWR Morb Mortal Wkly Rep. 1991; 40:240. [PubMed 1848916]
154. Collignon P. Chloroquine resistance in Plasmodium vivax. J Infect Dis. 1991; 164:222-3. [IDIS 284165] [PubMed 2056216]
161. Schwartz IK, Lackritz EM, Patchen LC. Chloroquine-resistant Plasmodium vivax from Indonesia. N Engl J Med. 1991; 324:927. [IDIS 279271] [PubMed 2000121]
162. Wyler DJ. Malaria chemoprophylaxis for the traveler. N Engl J Med. 1993; 329:31-7. [IDIS 316065] [PubMed 8505942]
163. World Health Organization. International travel and health: vaccination requirements and health advice. Geneva: World Health Organization; 2001. From WHO web site.
164. Wyler DJ. Malaria: overview and update. Clin Infect Dis. 1993; 16:449-58. [IDIS 312108] [PubMed 8513046]
165. Bradley D. Prophylaxis against malaria for travelers from the United Kingdom. BMJ. 1993; 306:1247-52. [IDIS 313802] [PubMed 8499856]
166. World Health Organization. WHO model prescribing information: drugs used in parasitic diseases. Geneva, Switzerland: WHO; 1992:62-77.
167. Meeran K, Jacobs MG, Scott J et al. Chloroquine poisoning: rapidly fatal without treatment. BMJ. 1993; 307:49-50. [IDIS 317216] [PubMed 8343674]
168. Wilkinson R, Mahatane J, Wade P et al. Chloroquine poisoning. BMJ. 1993; 307:504. [IDIS 319240] [PubMed 8400953]
169. Laurenson IF, Naraqi S, Lalloo DG et al. Chloroquine overdose in Papua New Guinea. BMJ. 1993; 307:564-5. [PubMed 8400996]
170. Kivistö KT, Neuvonen PJ. Activated charcoal for chloroquine poisoning. BMJ. 1993; 307:1068. [IDIS 321971] [PubMed 8305074]
171. Mirochnick M, Barnett E, Clarke DF et al. Stability of chloroquine in an extemporaneously prepared suspension stored at three temperatures. Ped Infect Dis J. 1994; 13:827-8.
174. Anon. Drugs for parasitic infections. From the Medical Letter website. Aug 2008.
175. Lobel HO, Kozarsky PE. Update on prevention of malaria for travelers. JAMA. 1997; 278:1767-71. [IDIS 395515] [PubMed 9388154]
176. Centers for Disease Control and Prevention. Health information for international travel, 2010. Atlanta, GA: US Department of Health and Human Services; 2010. Updates available from CDC website.
177. Wolfe MS. Protection of travelers. Clin Infect Dis. 1997; 25:177-86. [IDIS 392200] [PubMed 9332506]
178. Committee on Infectious Diseases, American Academy of Pediatrics. Red book: 2003 report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:192-4,414-9.
180. Baguet JP, Tremel F, Fabre M. Chloroquine cardiomyopathy with conduction disorders. Heart. 1999; 81:221-3. [IDIS 423686] [PubMed 9922366]
181. Reuss-Borst M, Berner B, Wulf G et al. Complete heart block as a rare complication of treatment with chloroquine. J Rheumatol. 1999; 26:1394-5. [IDIS 429747] [PubMed 10381062]
182. Centers for Disease Control and Prevention. Human rabies prevention—United States, 1999: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1999; 48(No. RR-1):1-21.
183. Centers for Disease Control and Prevention. CDC treatment guidelines: Treatment of malaria (guidelines for clinicians). 2007 Mar. From the CDC website.
184. Bayer. Biltricide (praziquantel) tablets prescribing information. West Haven, CT; 2004 Aug.
185. Sarkany RP. The management of porphyria cutanea tarda. Clin Exp Dermatol. 2001; 26:225-32. [PubMed 11422163]
186. Wallace DJ. The use of chloroquine and hydroxychloroquine for non-infectious conditions other than rheumatoid arthritis or lupus: a critical review. Lupus. 1996;5 (Suppl 1):S59-64.
187. Badminton MN, Elder GH. Management of acute and cutaneous porphyrias. Int J Clin Pract. 2002; 56:272-8. [IDIS 482137] [PubMed 12074210]
188. Baltzan M, Mehta S, Kirkham TH et al. Randomized trial of prolonged chloroquine therapy in advanced pulmonary sarcoidosis. Am J Respir Crit Care Med. 1999; 160:192-7. [IDIS 432954] [PubMed 10390399]
189. Fazzi P. Pharmacotherapeutic management of pulmonary sarcoidosis. Am J Respir Med. 2003; 2:311-20. [PubMed 14719997]
190. Roche Laboratories. Fansidar (sulfadoxine and pyrimethamine) tablets prescribing information. Nutley, NJ; 2004 Aug.
191. Centers for Disease Control and Prevention. Guidelines for treatment of malaria in the United States (based on drugs currently available for use in the United States). From the CDC website. Accessed 2009 Jul 1.
a. AHFS Drug Information 2004. McEvoy GK, ed. Chlorquine Hydrochloride and Chloroquine Phosphate. Bethesda, MD: American Society of Health-System Pharmacists; 2004:822-7.
c. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 6th ed. Philadelphia; PA: Lippincott Wiliams & Wilkins; 2002:239-41.
More Chloroquine Phosphate resources
- Chloroquine Phosphate Side Effects (in more detail)
- Chloroquine Phosphate Dosage
- Chloroquine Phosphate Use in Pregnancy & Breastfeeding
- Drug Images
- Chloroquine Phosphate Drug Interactions
- Chloroquine Phosphate Support Group
- 0 Reviews for Chloroquine Phosphate - Add your own review/rating
- Chloroquine MedFacts Consumer Leaflet (Wolters Kluwer)
- Chloroquine Prescribing Information (FDA)
- Chloroquine Professional Patient Advice (Wolters Kluwer)
- Aralen Phosphate Concise Consumer Information (Cerner Multum)
- Aralen Phosphate Advanced Consumer (Micromedex) - Includes Dosage Information
Compare Chloroquine Phosphate with other medications
- Amebiasis
- Malaria
- Malaria Prevention
- Sarcoidosis
