HCQ (Hydroxychloroquine Sulphate)
Also sold as: HCQS, Plaquenil, Hyqia, Oxiq
Pregnancy
Cat C
Lactation
Safe
Schedule
H
Forms
Tablet 200/300/400mg
Indications
- Rheumatoid arthritis (DMARD)
- SLE (cornerstone therapy)
- Sjögren syndrome
- Discoid lupus
- Malaria prophylaxis (chloroquine-sensitive areas)
Adult Dosing
RA/SLE
200-400 mg PO OD with food; max 5 mg/kg actual body weight to minimize retinopathy
Malaria prophylaxis
400 mg PO weekly, start 1-2 weeks before travel
Pediatric Dosing
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl < 30 | Caution — monitor levels and toxicity |
Hepatic Adjustment
Caution in hepatic impairment
Pregnancy & Lactation
Pregnancy: Category C
Generally continued in SLE pregnancy (risk of flare > drug risk). Effective for SLE control.
Lactation: Safe
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| QT-prolonging drugs (azithromycin, ondansetron, citalopram) | Additive QT prolongation | Major |
| Digoxin | Increased digoxin levels | Moderate |
| Insulin, sulfonylureas | Hypoglycemia | Moderate |
| Antacids | Reduced HCQ absorption — separate by 4 hours | Moderate |
| Methotrexate | Beneficial combination in RA | Minor |
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Side Effects
Common
- Nausea, GI upset
- Headache
- Dizziness
- Skin pigmentation
- Hair lightening
Serious / Discontinue If
- Retinopathy (cumulative dose >1000g, >5 years use; irreversible bull's eye maculopathy)
- Cardiomyopathy (rare, long-term)
- QT prolongation
- Hypoglycemia in non-diabetics
- Hemolysis in G6PD deficiency
- Severe hypersensitivity
Contraindications
- Pre-existing retinopathy
- Hypersensitivity to 4-aminoquinolines
- G6PD deficiency (relative)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| HCQS 200 | IPCA | 10 tab ₹65 |
| Hyqia 200 | Sun Pharma | 10 tab ₹85 |
| Oxiq 200 | Zydus | 10 tab ₹78 |
Monitoring Required
- Baseline ophthal exam at start, then annually after 5 years (or sooner if risk factors)
- CBC, LFT periodically
Patient Counseling Points
- Take with food
- Annual eye exam essential
- Continue indefinitely for SLE
- Effect takes 8-12 weeks
- Report visual changes immediately
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References
- BNF
- Lexicomp Drug Information
- Indian National Formulary
- Specialty society guidelines (RSSDI/CSI/IAP)