Hydroxychloroquine Sulfate

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Aug 01, 2022

Warnings

Hydroxychloroquine Risks, Warnings, and Complications

Hydroxychloroquine can cause serious health problems, especially in certain high-risk people. Some of the risks of hydroxychloroquine use include:

PERMANENT EYE DAMAGE: Long-term treatment with hydroxychloroquine can damage the retina in the eye and cause blurred vision and problems with reading. These effects can continue even after you stop hydroxychloroquine. Your doctor may order an eye exam before starting treatment with hydroxychloroquine and ask you to get regular eye exams while on this medicine. There is an increased risk of irreversible eye damage with high doses and long-term use of hydroxychloroquine for more than 5 years. People with pre-existing eye disease or kidney damage and those taking certain other medicines like tamoxifen are also at higher risk.
HEART PROBLEMS: In some people, hydroxychloroquine can cause ventricular tachycardia and ventricular fibrillation (problems with heart rhythm). This can occur with both long-term and short-term use. Keep all your appointments with your doctor as they may want to keep an eye on your heart during hydroxychloroquine treatment. Tell your doctor or seek immediate medical care if you feel lightheaded or dizzy or experience chest pain or rapid heartbeat while on this medicine. The risks of heart problems on hydroxychloroquine are higher in people with pre-existing heart conditions and those taking other medicines that affect heart rhythm.
WORSENING PORPHYRIA AND PSORIASIS: People with porphyria and psoriasis may experience a severe worsening of their conditions while on hydroxychloroquine. Give your healthcare professional a complete medical history and tell them if you have psoriasis or porphyria before starting hydroxychloroquine.
MUSCLE WEAKNESS: Long-term use of hydroxychloroquine can lead to muscle weakness in some people. If you are on hydroxychloroquine for the long term, your doctor may test your muscle strength and reflexes at regular intervals.
SEVERE HYPOGLYCEMIA: Some people can experience hypoglycemia (extremely low blood sugar), leading to loss of consciousness while on hydroxychloroquine. This can happen even if you’re not on any diabetes medications. If you are on diabetes medicines, talk to your doctor about any dosage adjustment that may be necessary.

Talk to your doctor or pharmacist about the risks of hydroxychloroquine. Call your doctor immediately if you experience any unusual symptoms while on this medication.

Precautions Before Starting Hydroxychloroquine

Tell your doctor if you have previously had an allergic reaction to hydroxychloroquine, chloroquine, quinine, primaquine, or any other medications.

Give your doctor a complete medical history. Hydroxychloroquine may not be right for people with certain medical conditions such as liver disease, heart disease, QT prolongation, irregular heartbeat, low magnesium, low potassium, psoriasis, porphyra, G6PD deficiency, dermatitis, vision problems, seizures, renal insufficiency (reduced renal function), diabetes, or heavy alcohol use. Tell your doctor if you have ever had vision problems while on hydroxychloroquine or chloroquine.

Give your doctor a complete list of your medications, including all prescription and nonprescription drugs, nutritional supplements, vitamins, and natural products. This can help avoid serious drug interactions.

Tell your doctor if you are pregnant, could be pregnant, plan to become pregnant, or are breastfeeding.

Precautions During Use of Hydroxychloroquine

Keep all appointments with your doctor during hydroxychloroquine treatment. Your doctor may want to order eye exams or perform muscle strength testing while you’re on this medicine.

Take antacids at least 4 hours away from hydroxychloroquine and ampicillin at least 2 hours away from hydroxychloroquine.

Call your doctor if you become pregnant while on hydroxychloroquine.

Hydroxychloroquine Drug Interactions

Taking hydroxychloroquine with some other drugs can affect how it works. Interactions can also increase the risk of serious side effects. Your physician may choose a different medication, change the dose or frequency of one or both medicines, and/or monitor you carefully for side effects if there are known interactions between hydroxychloroquine and your other medications.

There can be interactions between hydroxychloroquine and medicines such as:

Acetaminophen (Tylenol)
Antibiotics like azithromycin (Zithromax) and moxifloxacin (Avelox)
Drugs used to treat stomach acidity and ulcers such as cimetidine (Tagamet)
Immunosuppressants like cyclosporine (Neoral, Gengraf, Sandimmune)
Heart medications like digoxin (Lanoxin)
Insulin and oral medication for diabetes
Some medications used to treat irregular heartbeat such as amiodarone (Pacerone)
Anti-seizure medications such as carbamazepine (Tegretol, Carbatrol, Equetro, Epitol, Teril), valproic acid (Depakene), and phenytoin (Dilantin, Phenytek)
Cancer treatment drugs like methotrexate (Trexall, Xatmep) and tamoxifen (Nolvadex)
Anti-parasitic drugs like praziquantel (Biltricide)

This list does not describe all possible hydroxychloroquine interactions. Give your healthcare providers a complete list of your medications, including prescription drugs, over-the-counter medicines, dietary supplements, and herbal products. Also, tell your healthcare providers if you smoke, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications or increase the risk of side effects when used with prescription medications.

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