Alfuzosin
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Drug reference
Hydroxychloroquine
4-aminoquinoline antimalarial / disease-modifying antirheumatic drug (DMARD) · Antirheumatic
Also known as Hydroxychloroquine sulfate, HCQ, Plaquenil
START
Baseline ophthalmologic exam (visual acuity, OCT, visual fields, fundoscopy) if using >3 months. Verify actual body weight for dosing (<5mg/kg/day). Check glucose (risk of hypoglycemia).
TYPICAL MAX
Never exceed 400mg/day or 5mg/kg/day actual body weight. Retinopathy risk is cumulative and dose-dependent.
STOP IF
Any visual changes, new cardiomyopathy symptoms, severe hypoglycemia, blood dyscrasia, severe myopathy.
WATCH
Ophthalmologic screening per AAO guidelines: baseline within 1 year of starting, then annually after 5 years (or sooner with risk factors). Real body weight dosing critical—obesity increases retinopathy risk if dosed by ideal body weight. ECG if cardiac disease. Blood glucose monitoring (especially with diabetes). May worsen psoriasis.
CDSCO approvedJan AushadhiATC P01BA02
KDIGO 2024 + manufacturer label
- ONSET
- 1h · Onset ~1 hour
- PEAK
- 3h · Tmax 2-4.5 hours
- t½
- 5.7w · Terminal t½ ~40-50 days
- DURATION
- 1w · Weekly (prophylaxis)
EXCRETION
Renal unchanged and metabolites (~50%)
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Preferred DMARD in pregnancy—continued benefit outweighs risk. Does not increase teratogenic risk. Fetal AV block risk in anti-Ro/SSA-positive mothers—monitor fetal echocardiography. Crosses placenta.
FDA category + note
Top interactionssee all 12 →
- AlfuzosinSevereDatabaseDDInter
- AlimemazineSevereDatabaseDDInter
- AmiodaroneSevereDatabaseKimi deep-research + Cla
- AmisulprideSevereDatabaseDDInter
Available in India
97 branded formulations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
In malaria: concentrates in parasite food vacuole, inhibiting heme polymerization. In autoimmune disease: accumulates in lysosomes, raising pH and inhibiting antigen presentation; blocks Toll-like receptor signaling; reduces cytokine production (TNF-α, IL-1, IL-6); inhibits T-cell activation.
Indications
Systemic lupus erythematosus (SLE)—first-line therapyRheumatoid arthritis (monotherapy or combination DMARD)Discoid lupus erythematosusCutaneous lupusAntiphospholipid syndrome (adjunctive)Malaria prophylaxis and treatment (chloroquine-resistant areas—limited)Sjögren's syndrome (off-label)Q fever (chronic, with doxycycline)Porphyria cutanea tarda (off-label)
Dosing
- Adult
- SLE/RA: 200-400mg PO daily (max 5mg/kg/day actual body weight; never exceed 400mg/day). Typically 200mg daily for SLE maintenance; 200-400mg for RA. Malaria prophylaxis: 400mg weekly starting 2 weeks before travel. Malaria treatment: 800mg, then 400mg at 6, 24, and 48 hours.
- Pediatric
- SLE/RA: 3-5mg/kg/day (max 400mg). Malaria prophylaxis: 5mg/kg weekly (max 400mg).
- Renal adjustment
- No adjustment needed for mild-moderate. Severe: reduce dose 50%.
- Hepatic adjustment
- No specific guidance; use caution.
- Geriatric
- No specific adjustment; higher retinopathy risk with age—strict eye screening essential.
- Max dose
- 5mg/kg/day actual body weight; never exceed 400mg/day (chronic use)
Pharmacokinetics
Onset
Antimalarial: within 24-48h. DMARD effect: 3-6 months for RA/SLE
Peak effect
Tmax 2-4.5 hours; steady-state tissue concentrations in 3-4 months
Duration
Terminal elimination half-life determines duration: weeks to months
Half-life
~40-50 days (terminal); α-phase 3-8h; β-phase 40-216h
Bioavailability
~75%
Protein binding
~50%
Metabolism
Hepatic via CYP2C8, CYP3A4/5; major metabolite desethylhydroxychloroquine (active)
Excretion
~50% renal (unchanged + metabolites); slow tissue release over months
Contraindications
- Hypersensitivity to 4-aminoquinolines
- Pre-existing retinopathy or macular degeneration
- Long-term therapy in children (cumulative toxicity risk)
- Psoriasis (may exacerbate—relative)
Side effects
Common
Gastrointestinal upset (nausea, diarrhea, cramps)HeadacheRash / pruritusSkin discoloration (gray-blue)InsomniaDizziness
Serious
- Retinopathy (bull's eye maculopathy—risk <1% at 5 years, ~20% at 20 years with daily dosing; may be irreversible)
- Cardiomyopathy / QT prolongation
- Blood dyscrasias
- Severe hypoglycemia
- Neuropsychiatric effects (seizures, psychosis)
- Myopathy / neuromyopathy
Pregnancy & lactation
Pregnancy
Preferred DMARD in pregnancy—continued benefit outweighs risk. Does not increase teratogenic risk. Fetal AV block risk in anti-Ro/SSA-positive mothers—monitor fetal echocardiography. Crosses placenta.
Lactation
Excreted in breast milk (~2-3% of maternal dose); infant exposure very low. Compatible with breastfeeding per AAP. Safe during lactation.
Drug interactions
Alimemazine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Amiodarone
Severe
Database
Additive QT prolongation; risk of torsades de pointes.
Avoid combination; if essential, monitor ECG and correct electrolytes.
Source: Kimi deep-research + Cla
Amisulpride
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Amitriptyline
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Amoxapine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Anagrelide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Apomorphine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Arsenic Trioxide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Asenapine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Astemizole
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Atomoxetine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Ask House about Hydroxychloroquine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19