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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Chloroquine

Paul A. Pham Pharm.D. and John G. Bartlett M.D.
10-13-2010

Zambia Specific Information

  • Available formulation in Zambia: Oral liquid: 50 mg (as phosphate or sulfate)/5 ml. Tablet: 100 mg; 150 mg (as phosphate or sulfate).
  • Chloroquine resistance common in Plasmodium falciparum malaria.
  • Still maintains considerable efficacy for the treatment of P. vivax, P. ovale and P. malariae infections.
  • P. ovale and P. vivax malaria: chloroquine 600 mg x 1, followed by 300 mg 6-8hrs later, and 300 mg once-daily on second and third day PLUS primaquine.
  • P. malariae: chloroquine 600 mg x 1, followed by 300 mg 6-8hrs later, and 300 mg once-daily on second and third day (no primaquine needed).

REFERENCES

Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

  • Malaria prophylaxis and treatment (caused by P. vivax, P. malariae, P. ovale, and chloroquine-susceptible strains of P. falciparum)
  • Amebic liver abscess

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
Aralen phosphateChloroquine phosphate~Various generic manufacturersPO
tab
250mg
$2.47
      PO
tab
500mg
$5.64

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

P. vivax, P. ovale, P. malariae, & chloroquine-sensitive P. falciparum: chloroquine phosphate 1gm salt (600mg base) once, then 500mg mg salt (300mg base) 6hr later, then 500mg at 24 h and 48h. Chloroquine HCL 160-200 mg (base) IM or IV q6h (IV n/a in US).

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

150-300mg PO once daily.

DOSING IN HEMODIALYSIS

No data.

DOSING IN PERITONEAL DIALYSIS

No data.

DOSING IN HEMOFILTRATION

No data.

ADVERSE DRUG REACTIONS

OCCASIONAL

  • Visual disturbances
  • Hemolysis with G6PD deficiency.
  • GI intolerance
  • Pruritus
  • Weight loss
  • Alopecia
RARE

  • CNS: headache, confusion, dizziness, and psychosis
  • Peripheral neuropathy
  • Extraocular muscle palsies
  • QTc prolongation
  • Corneal opacities and retinopathy
  • Pancytopenia
  • Erythema multiforme, Steven-Johnson syndrome, and toxic epidermal necrolysis

DRUG INTERACTIONS

  • Any drugs that can prolong QTc (macrolides, antipsychotics, tricyclic antidepressants, amiodarone, fluoroquinolones, methadone...): may result in additive QTc prolongation with chloroquine co-administration. Avoid co-administration.
  • Aluminum and magnesium salts: decrease absorption of chloroquine. Administer chloroquine 2-4 hours before antacid.
  • Cimetidine: may increase chloroquine serum concentrations. Monitor for toxicity.
  • Mefloquine: co-administration may increase risk of seizure.
  • Rabies vaccine: may decrease rabies-neutralizing antibody titer with chloroquine co-administration (NEJM 1986; 314: 280).

SPECTRUM

P. vivax, P. ovale, P. malariae, and chloroquine-sensitive P. falciparum.

PHARMACOLOGY

Pharmacology

COMMENTS

Oral antimalarial agent. Effective as malaria prophylaxis in Mexico and Central America above the Panama Canal. Some chloroquine resistance in the Middle East. Substantial resistance in continental South America. Mefloquine or Malarone recommended for travel to areas with chloroquine-resistant P. falciparum. Use with caution in pts with history of seizures and visual field changes.

REFERENCES

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