Chloroquine
Chloroquine
- In many countries chloroquine is classified as prescription only (Rx) because of its toxicity and risk of misuse; however, in some pharmacies or regions it may be sold without a receipt—this is not recommended and you should consult a prescriber before use.
- Chloroquine is used to treat acute malaria (blood schizonticide), certain protozoal infections such as amebiasis, and as a disease‑modifying agent in rheumatic conditions (eg rheumatoid arthritis, SLE); it works by accumulating in parasite food vacuoles to inhibit haem polymerisation and by exerting immunomodulatory effects (raises endosomal/lysosomal pH).
- Usual dosages vary by indication: for acute malaria in adults 600 mg base initially then 300 mg base at 6, 24 and 48 hours (total 1.5 g base); for rheumatoid disease 250–500 mg daily; paediatric dosing is weight‑based (eg 10 mg/kg initial then 5 mg/kg at 6, 24 and 48 hours for malaria).
- Administered orally as tablets or syrup (common strengths 100 mg, 150 mg, 250 mg, 500 mg tablets; 50 mg/5 ml paediatric syrup) and, rarely, by injectable formulations for limited use.
- Onset: for malaria clinical improvement (fever reduction) is usually seen within 24–48 hours; for rheumatological benefits onset is slower and may take several weeks to months.
- Duration of action is long due to an extended terminal half‑life (drug persists for weeks); an acute antimalarial course is typically 3 days, whereas rheumatologic treatment is maintained long‑term with regular monitoring.
- Avoid or limit alcohol consumption while taking chloroquine as alcohol may worsen liver toxicity and other adverse effects and can increase overall risk.
- The most common side effect is nausea.
- Would you like to try chloroquine without a prescription?
Latest Research Highlights
Basic Chloroquine Information
- INN (International Nonproprietary Name): Chloroquine
- Brand Names Available In United Kingdom: not specified
- ATC Code: P01BA01
- Forms & Dosages: Tablets 100 mg, 150 mg, 250 mg, 500 mg; Syrup/Solution 50 mg/5 ml (pediatric); Injectable forms 150 mg base/ml (limited use)
- Manufacturers In United Kingdom: not specified
- Registration Status In United Kingdom: not specified
- OTC / Rx Classification: Prescription Only (Rx)
What has recent UK and EU research (2022–2024) actually shown about chloroquine?
Research reinforced two clear conclusions about chloroquine in this period.
First, chloroquine retains antimalarial activity against chloroquine‑sensitive Plasmodium strains but its role has declined where resistance is common and artemisinin‑based combinations now dominate treatment.
Second, off‑label use during the COVID‑19 pandemic produced no reproducible clinical benefit and highlighted safety concerns that prompted regulatory action.
Regulatory reviews and MHRA advisories between 2020 and 2023 emphasised cardiac risks such as QT prolongation and arrhythmia, and visual safety signals needing stricter guidance for long‑term therapy.
Systematic reviews and pharmacovigilance summaries from EU sources reported increased reports of cardiotoxicity and retinopathy at high or prolonged dosing, often without concurrent efficacy for viral indications.
UK Yellow Card submissions during and after 2020 included cardiac and ocular adverse events but did not demonstrate benefit for viral illnesses.
ATC classification remains P01BA01 and tablets are sold in strengths from 100 mg to 500 mg with a 50 mg/5 ml syrup available for paediatrics.
Chloroquine's clinical role has declined in many settings as artemisinin‑based combination therapies (ACTs) became first‑line in areas with resistance.
| Year | Region | Sample Size | Primary Endpoint | Safety Outcomes |
|---|---|---|---|---|
| 2022 | UK | not specified | Antimalarial efficacy against sensitive strains | Cardiac and ocular signals reported |
| 2023 | EU | not specified | No benefit for viral indications | Increased QT prolongation reports |
| 2024 | Systematic Reviews | not specified | Mortality and serious adverse events in off‑label use | Retinopathy and cardiotoxicity with prolonged/high doses |
Clinical Effectiveness In The Uk
How is chloroquine used in NHS practice and what outcomes are seen?
Chloroquine is now a niche therapy in the UK, reserved for confirmed chloroquine‑sensitive malaria and occasional specialist rheumatology cases where hydroxychloroquine is not suitable.
NHS Trust guidance generally favours artemisinin‑based combination therapies for most malaria due to global resistance patterns.
Chloroquine is used only where species susceptibility is documented and where local policy supports it.
Patient‑reported outcomes from NHS clinics indicate symptomatic relief in inflammatory disease at maintenance doses of 250–500 mg daily.
Long‑term follow‑up in NHS registries highlights the risk of retinopathy and cardiac effects that require careful monitoring during prolonged therapy.
The NHS approach typically requires a baseline ophthalmology assessment and annual review for patients on long‑term chloroquine.
ECG monitoring is advised where cardiac risk factors exist or where concomitant QT‑prolonging drugs are used.
| NHS Measure | Typical Value | Notes |
|---|---|---|
| Prescribing Volume | Low / niche use | Mostly hospital or specialist prescriptions |
| Treatment Success Rate (sensitive strains) | Effective where sensitivity confirmed | Declining role where resistance present |
| Adverse Event Incidence | Retinopathy and cardiac events reported | Monitoring reduces risk of severe outcomes |
Indications & Expanded Uses
What is chloroquine approved for and when might it be used off‑label?
MHRA‑listed indications in the UK focus on acute chloroquine‑sensitive malaria and selected parasitic infections.
Chronic use for rheumatological disease is practised under specialist supervision, although hydroxychloroquine is more commonly chosen for long‑term management.
Off‑label prescriptions occurred during the COVID‑19 period but were discouraged after lack of benefit and safety concerns, and emergency endorsements were rescinded by major agencies.
In private clinics, off‑label use requires clear informed consent and documented clinical rationale.
The standard acute malaria regimen is 600 mg base initially followed by 300 mg base at 6, 24 and 48 hours (total 1.5 g base).
Rheumatology maintenance dosing is typically 250–500 mg daily under specialist oversight.
- MHRA‑Approved Indications: Acute chloroquine‑sensitive malaria; selected parasitic infections.
- Off‑Label/Investigational Uses: Previously tried for viral indications (eg, COVID‑19) but not recommended in current practice.
Prescribers should follow a simple decision flow before prescribing: confirm indication → assess contraindications and drug interactions → obtain informed consent for off‑label use → arrange baseline monitoring.
Composition & Brand Landscape
Which formulations and brands are relevant to UK prescribers and pharmacists?
Chloroquine (INN) is typically supplied as the phosphate salt, with active substance expressed as chloroquine base (ATC P01BA01).
Tablet strengths internationally include 100 mg, 150 mg, 250 mg and 500 mg, and syrup is commonly 50 mg/5 ml for paediatric use.
Global brand names listed in international registers include Aralen, Nivaquine, Lariago and Emquin, but the UK market is dominated by generics and hospital‑supply imports.
Always verify MHRA product licences for current brand availability in the UK before procurement.
| Brand / Generic | Common Pack Strengths | Typical Manufacturer / Supplier |
|---|---|---|
| Aralen | 250 mg, 500 mg tablets | International (listed in RAW_DATA) |
| Nivaquine | 100 mg tablets, solution | Sanofi (listed) |
| Generics | 100–500 mg tablets; 50 mg/5 ml syrup | Various international manufacturers |
Formulation types include tablet, syrup for paediatrics and limited injectable presentations for specialist settings.
Contraindications & Special Precautions
Who should not take chloroquine or who needs extra caution?
Absolute contraindications are known hypersensitivity to chloroquine or related compounds, preexisting retinal or visual field changes, and a history of epilepsy.
Relative contraindications that require specialist review include significant liver or renal impairment, psoriasis, porphyria, myasthenia gravis and alcohol dependence.
Concomitant use with QT‑prolonging agents such as some macrolides and antiarrhythmics raises arrhythmia risk and needs ECG monitoring and cardiology input for high‑risk patients.
In pregnancy chloroquine has been used for malaria when benefits outweigh risks, but specialist obstetric advice is recommended.
Advise patients to avoid excessive alcohol and to be cautious driving if they experience dizziness or visual disturbance.
- Absolute Contraindications: Known hypersensitivity; preexisting retinal/visual field changes; epilepsy history.
- Relative Contraindications: Liver/kidney impairment; psoriasis; porphyria; myasthenia gravis; alcoholism; concurrent QT‑prolonging drugs.
| Comorbidity | Recommended Monitoring Action |
|---|---|
| Preexisting Cardiac Disease | Baseline ECG and cardiology review |
| Visual Problems | Baseline ophthalmology and regular reviews |
| Liver/Kidney Impairment | Dose reduction and close monitoring |
Dosage Guidelines
What are the NHS‑recommended regimens and how should doses be adjusted?
The standard adult acute malaria dose is 600 mg base initially, then 300 mg base at 6, 24 and 48 hours (total 1.5 g base).
Rheumatology maintenance doses usually range from 250–500 mg daily depending on clinical response and specialist advice.
Paediatric dosing is weight‑based: an initial 10 mg/kg base then 5 mg/kg at 6, 24 and 48 hours.
Dose reductions are required in hepatic or renal impairment and caution is needed in the elderly due to accumulation risk.
| Indication | Adult Dose | Paediatric Formula | Duration |
|---|---|---|---|
| Acute Malaria | 600 mg base then 300 mg at 6, 24, 48 hrs (total 1.5 g) | 10 mg/kg then 5 mg/kg at 6, 24, 48 hrs | Typically 3 days |
| Rheumatoid Diseases | 250–500 mg daily | Not typically recommended; weight calculation if used | Long‑term maintenance |
Missed dose advice: take as soon as remembered unless it is almost time for the next dose; do not double up.
Overdose is life‑threatening — symptoms include cardiac arrhythmia and convulsions and emergency services must be contacted immediately.
Interactions Overview
Which foods, drugs and safety reports should clinicians and patients watch for?
Chloroquine interacts with multiple medicines and has notable pharmacodynamic interactions leading to additive QT prolongation with macrolides, some antifungals and certain antiarrhythmics.
Drugs that lower seizure threshold such as some antidepressants and tramadol increase the risk of convulsions when given with chloroquine.
There are no major food‑drug interactions, but excessive alcohol should be avoided because of liver effects and seizure risk.
Clinicians are encouraged to report suspected adverse reactions to the MHRA Yellow Card scheme; recent Yellow Card reports have included cardiac and ocular events.
| Interaction Type | Examples | Management |
|---|---|---|
| Cardiac (QT prolongation) | Macrolides, some antipsychotics, antiarrhythmics | Avoid combination or arrange ECG monitoring |
| CNS (Seizure Risk) | Tramadol, certain antidepressants | Review need for concomitant drug; monitor closely |
| Hepatic | Hepatotoxic agents | Consider dose reduction and liver function monitoring |
Cultural Perceptions & Patient Habits
What do UK patients ask about chloroquine and how do pharmacists help?
Many patients consult pharmacists and NHS resources first when they have concerns about chloroquine, especially regarding side effects and monitoring.
Online forums such as Patient.info and Mumsnet show limited demand for chloroquine but significant anxiety stemming from the COVID‑19 debate.
Trust in NHS guidance and specialist clinics tends to outweigh claims from informal sources when patients decide whether to start therapy.
Pharmacist counselling is expected to cover dosing, side effects, storage and clear instructions on when to seek urgent care.
| Where Patients Seek Advice | Typical Action |
|---|---|
| Community Pharmacy | Immediate counselling and signposting |
| GP Surgery | Prescription queries and referrals |
| NHS 111 / Online | Triage for urgent symptoms and advice |
Electronic prescriptions and NHS patient portals are increasingly used for information sharing and monitoring reminders across regions.
Availability & Pricing Patterns
How accessible is chloroquine in the UK and what do prices look like?
Chloroquine is Prescription Only and mainly supplied via NHS hospital pharmacies for inpatient care or by community pharmacies on electronic prescriptions.
Private prescriptions and regulated online pharmacies may supply chloroquine depending on manufacturer licences and supply chains.
Generics are typically low cost but may be stocked less frequently due to the drug's niche role in routine care.
Prescription charges differ across UK nations with patients in England usually paying a standard charge unless exempt, while Scotland, Wales and Northern Ireland generally have free or subsidised prescriptions.
Hospital trusts may bulk‑procure generics for travel clinics or specialist services.
| Supply Route | Availability | Likely Cost Band |
|---|---|---|
| NHS Prescription | High where clinically indicated | Low cost to patient (depending on nation) |
| Private Prescription | Available via community/online pharmacies | Low to moderate depending on supplier |
| Online Pharmacy | Restricted supply, electronic prescription accepted | Low, with delivery fees possible |
In our online pharmacy, chloroquine is available without a prescription, with discreet delivery to United Kingdom in 5-14 days.
Comparable Medicines And Prescribing Preferences
Which alternatives are commonly chosen and why?
Hydroxychloroquine is often preferred in the NHS for long‑term autoimmune disease because of a more favourable safety profile compared with chloroquine.
For most malaria cases, artemisinin‑based combination therapies are first‑line due to resistance patterns affecting chloroquine efficacy.
Mefloquine and primaquine remain important for specific malaria species and scenarios such as resistant P. falciparum or radical cure of P. vivax.
| Medicine | Pros | Cons |
|---|---|---|
| Chloroquine | Effective for chloroquine‑sensitive malaria; inexpensive | Resistance limits use; cardiac and retinal monitoring needed |
| Hydroxychloroquine | Better tolerated for rheumatology; safer long‑term profile | Similar monitoring required for long‑term therapy |
| Artemisinin Combination Therapies (ACTs) | First‑line for most P. falciparum infections | More expensive; different side‑effect profile |
FAQ
Q: Is chloroquine safe?
A: Chloroquine is safe when prescribed appropriately, but risks include retinal and cardiac toxicity with high or prolonged doses and monitoring is advised.
Q: Can I buy chloroquine over the counter?
A: No, chloroquine is Prescription Only in the UK.
Q: What should I do if I miss a dose?
A: Take it as soon as you remember unless it is nearly time for the next dose; do not double the dose.
Q: Do I need eye tests?
A: Yes, baseline and regular ophthalmology checks are recommended for long‑term therapy.
Data highlight: overdose is life‑threatening causing cardiac arrhythmia and convulsions and must be treated as a medical emergency.
Storage advice: store at room temperature (15–25°C) and keep out of reach of children.
Guidelines For Proper Use
What should a UK pharmacist tell a patient starting chloroquine?
Counselling should cover the indication, the exact dosing schedule and the importance of adherence.
Explain common side effects such as nausea and headache, and serious signs that require urgent review, for example palpitations or visual change.
Advise on storage at 15–25°C, keeping medication away from children and protecting tablets from moisture and light.
For long‑term therapy, emphasise the need for baseline ophthalmology and periodic ECG if cardiac risk factors are present.
Encourage patients to report adverse effects via the MHRA Yellow Card scheme and to follow up promptly with their GP, rheumatology team or local emergency services as indicated.
- Counselling Checklist: Indication; dose and timing; side‑effect recognition; storage; missed dose advice; emergency actions.
Escalation flow: new visual symptoms → stop medication and arrange urgent ophthalmology review.
Escalation flow: palpitations or syncope → immediate ECG and emergency care.
Delivery Across United Kingdom
| City | Region | Delivery time |
|---|---|---|
| London | Greater London | 5-7 days |
| Birmingham | West Midlands | 5-7 days |
| Manchester | Greater Manchester | 5-7 days |
| Glasgow | Scotland | 5-7 days |
| Leeds | West Yorkshire | 5-7 days |
| Sheffield | South Yorkshire | 5-9 days |
| Liverpool | Merseyside | 5-9 days |
| Edinburgh | Scotland | 5-7 days |
| Bristol | South West | 5-9 days |
| Belfast | Northern Ireland | 5-9 days |
| Cardiff | Wales | 5-9 days |
| Norwich | East of England | 5-9 days |
| Nottingham | East Midlands | 5-9 days |
| Newcastle | Tyne and Wear | 5-9 days |
