Hydroxychloroquine Uses: Dosages & Treatments Explained
Key takeaways:
Hydroxychloroquine (Plaquenil) is a prescription medication that treats health conditions like malaria, rheumatoid arthritis, and lupus. You shouldn’t take hydroxychloroquine for COVID-19.
Hydroxychloroquine comes as an oral tablet. It’s short-term medication for malaria treatment and prevention. But, you’d likely take it long term if you have rheumatoid arthritis or lupus.
Community pharmacies often stock hydroxychloroquine as a brand-name and generic product. But if you’re trying to fill a hydroxychloroquine prescription for an off-label use, you may run into some restrictions at the pharmacy.
When COVID-19 first came around, health experts first turned to medications like hydroxychloroquine (Plaquenil) as one option to fight the fast-spreading virus. At one point, it was even authorized to treat it.
This is no longer the case. You shouldn’t take hydroxychloroquine to treat COVID — no matter if you’re in the hospital or recovering at home. Data shows that it’s not effective at fighting COVID, and it has some risks linked to it.
That said, hydroxychloroquine is still an effective treatment for other health conditions.
What is hydroxychloroquine?
Hydroxychloroquine is an oral, prescription-only medication that’s been around for decades. It’s available on pharmacy shelves as a name-brand and generic tablet.
Depending on what you need it for, hydroxychloroquine works in a few ways. It’s a type of nonbiologic disease-modifying anti-rheumatic drug (DMARD) for inflammatory health conditions. It can also kill certain parasites that cause malaria.
You may also be wondering if this is the same as a medication called chloroquine. They’re slightly different medications that share a similar chemical structure. They’re also prescribed for similar reasons, but hydroxychloroquine generally has less side effects.
What is hydroxychloroquine used for?
Hydroxychloroquine is FDA-approved for many health conditions:
Malaria prevention if you’re traveling to an area where malaria is common
Rheumatoid arthritis (adults only)
Systemic lupus erythematosus, the most common type of lupus (adults only)
Chronic discoid lupus erythematosus, a less common type of lupus (adults only)
Along with its official uses, hydroxychloroquine is sometimes used off-label for other reasons. Some healthcare providers prescribe it to treat conditions like:
Dermatomyositis, an inflammatory muscle and skin condition
Porphyria cutanea tarda, a rare skin disorder
Q fever, a bacterial illness
Sarcoidosis, an inflammatory condition that causes lumps throughout your body
Sjögren syndrome, an autoimmune condition known for causing dry mouth and dry eye
Can hydroxychloroquine treat COVID?
Hydroxychloroquine isn’t authorized or recommended by the FDA or CDC to treat COVID. It can’t prevent it either.
Medical organizations like the National Institutes of Health, World Health Organization, and Infectious Diseases Society of America have also released statements that recommend against the use of hydroxychloroquine for COVID. Data suggests that it doesn’t lower the risk of severe illness, mechanical ventilation, or death from the virus.
But there are other medications that are authorized or approved to treat COVID. Paxlovid (nirmatrelvir/ritonavir), remdesivir (Veklury), and molnupiravir (Lagevrio) are top examples.
How is hydroxychloroquine dosed and taken?
Hydroxychloroquine is available as an oral tablet. It comes in tablets ranging from 100 mg to 400 mg. It generally takes a few weeks to start working. Also, how much you take at a time depends on what you’re using it for.
| Health condition | Hydroxychloroquine dosage in adults | Treatment duration |
|---|---|---|
| Malaria treatment | First dose: 800 mg Second dose: 400 mg Third dose: 400 mg Fourth dose: 400 mg |
4 doses within a 48-hour period |
| Malaria prevention | 400 mg once weekly | Start 2 weeks before traveling; continue taking 4 weeks after returning home |
| Rheumatoid arthritis | 400–600 mg initially, followed by 200–400 mg once or twice daily | Indefinitely |
| Lupus | 200–400 mg once or twice daily | Indefinitely |
Hydroxychloroquine is also approved to treat and prevent malaria in kids. Specific dosages depend on their body weight, but they take the same number of doses as adults. But, kids that weigh less than 68 lbs (31 kg) aren’t eligible to take it.
Regardless of dose or age, you should take hydroxychloroquine with food or milk. Don’t take it on an empty stomach. You shouldn’t crush, chew, or split the tablets either. This helps prevent and lessen hydroxychloroquine side effects.
Is hydroxychloroquine safe?
Hydroxychloroquine is generally considered safe to take. The FDA only approves medications when their expected benefits outweigh their possible risks for specific conditions. Although, it still comes with risks and side effects.
Various side effects have been reported in clinical studies, such as:
Nausea and vomiting
Diarrhea
Stomach pain
Skin rashes
Dizziness
Ringing in the ears (tinnitus)
More serious side effects are also possible, although they are less common. There have been reports linking hydroxychloroquine to:
Heart problems, including heart failure and abnormal heart rhythms
Nerve pain
Muscle weakness
Severe skin rashes
Hallucination or psychosis
Suicidal thoughts
Your healthcare provider can tell you more about managing and preventing side effects like these.
Hydroxychloroquine also has several drug interactions that can affect its safety.
Hydroxychloroquine and COVID safety considerations
There have been occasional reports of heart-related safety problems among people with COVID who have taken hydroxychloroquine. This includes possibly serious heart rhythm changes and a dangerously fast heart rate.
These cardiac risks appear to be higher when combined with other medications that also affect your heart rhythm, such as azithromycin (Zithromax). People with COVID who have a history of heart or kidney problems are also at a higher risk of heart-related issues. Other non-heart-related risks have also been found, but they’re less common.
With effectiveness and side effect concerns in mind, health experts don’t recommend hydroxychloroquine as a treatment for COVID. When needed, it’s better to use a medication that’s FDA-approved or authorized for emergency use.
Where can I get hydroxychloroquine?
Hydroxychloroquine is available with a prescription from your healthcare provider. It’s not available over the counter. If your healthcare provider writes you a prescription for it, you can take it to a pharmacy near you.
It’s common for community pharmacies like CVS, Walgreens, and Walmart to keep hydroxychloroquine in stock. Independent pharmacies in your area may also have it. But if your preferred pharmacy is running low, you can ask your pharmacist about transferring your prescription to a different location.
What’s more, in 2020, many states implemented restrictions about who can get hydroxychloroquine. Depending on where you live and what pharmacy you go to, know that some of these restrictions may still be in place if you’re trying to fill hydroxychloroquine for an off-label use.
The bottom line
Hydroxychloroquine is a prescription medication that’s FDA-approved to treat malaria, rheumatoid arthritis, and two forms of lupus. It’s commonly found at pharmacies across the U.S. as a brand-name and generic medication.
Most people take 1 to 2 tablets per day, but the length of treatment depends on what you’re taking it for. Also, hydroxychloroquine isn’t authorized or recommended for COVID.
Why trust our experts?
References
American Medical Association. (2020). Joint statement on ordering, prescribing or dispensing COVID-19 medications.
A-S Medication Solutions. (2022). Hydroxychloroquine sulfate [package insert].
Hennekens, C. H., et al. (2022). Updates on hydroxychloroquine in prevention and treatment of COVID-19. The American Journal of Medicine.
Infectious Disease Society of America. (2022). IDSA guidelines on the treatment and management of patients with COVID-19.
National Academy for State Health Policy. (2020). State rules and recommendations regarding chloroquine, hydroxychloroquine and other drugs related to COVID-19.
National Institutes of Health. (n.d.). COVID-19 treatment guidelines.
Schwartz, I. S., et al. (2022). Hydroxychloroquine for COVID19: The curtains close on a comedy of errors. The Lancet.
Stokkermans, T. J., et al. (2022). Chloroquine and hydroxychloroquine toxicity. StatPearls.
U.S. Food and Drug Administration. (2020). Coronavirus (COVID-19) update: FDA revokes emergency use authorization for chloroquine and hydroxychloroquine.
U.S. Food and Drug Administration. (2020). FDA cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems.
World Health Organization. (2021). Coronavirus disease (COVID-19): Hydroxychloroquine.
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