Chloroquine

Basic Chloroquine Information

• INN (International Nonproprietary Name): Chloroquine
• Brand Names Available In Australia: not specified
• ATC Code: P01BA01 — Chloroquine (antimalarial agent)
• Forms & Dosages: Tablets 100 mg, 150 mg, 250 mg, 500 mg; Syrup/solution 50 mg/5 ml (paediatric); Injectable forms 150 mg base/ml (limited use)
• Manufacturers In Australia: not specified
• Registration Status In Australia: not specified
• OTC / Rx Classification: Prescription Only (Rx) in nearly all countries

Critical Warnings And Restrictions (Safety First)

High-Risk Groups (Elderly, Pregnancy, Chronic Illness)

Chloroquine is Prescription Only (Rx) in most countries and must be used under clinician oversight.

Absolute contraindications include known hypersensitivity to chloroquine or hydroxychloroquine, pre‑existing retinal or visual field changes, and a history of epilepsy.

Elderly people, pregnant or breastfeeding people, and those with cardiac disease, liver or kidney impairment, or seizure disorders are high risk and need dose adjustment, specialist input and closer monitoring.

Long‑term or high‑dose therapy increases the risk of retinopathy and cardiomyopathy; baseline and periodic ophthalmologic review is recommended.

Be aware of interactions with QT‑prolonging agents and drugs that lower the seizure threshold.

For Australian practice, ensure the indication is TGA‑approved, check PBS guidance if a subsidy is claimed, and document informed consent for any off‑label use.

Baseline Screening Checklist:

• ECG with QT interval assessment before starting therapy.
• Visual acuity and visual field testing (baseline ophthalmology review).
• Liver function tests (LFTs) and renal function tests.
• Medication review for QT‑prolonging or seizure‑threshold‑lowering drugs.
• Pregnancy test where relevant and pregnancy/breastfeeding counselling.

Interaction With Activities (Driving, Workplace Safety Under Australian Law)

Chloroquine can cause dizziness, blurred vision and mood changes; advise patients not to drive or operate heavy machinery until they know how it affects them.

Employers and health practitioners should consider workplace safety duties under Australian Work Health And Safety (WHS) laws when symptoms affect concentration or coordination.

For shift workers, heavy vehicle drivers or people in safety‑critical roles, document fitness for duty and consider temporary reassignment until symptoms resolve.

Provide written patient advice and record counselling in pharmacy or medical notes.

• Advise patients to avoid driving or operating machinery until symptom‑free.
• Document counselling in the patient record and provide written advice for employers if requested.
• Recommend temporary role changes for safety‑critical workers until cleared clinically.
• For ongoing symptoms, arrange clinical review and consider an ECG or ophthalmology referral as indicated.

Q&A — “Can I Drive After Taking It In Australia?”

Q: Can I drive after taking chloroquine?

A: Do not drive or operate machinery until you are free from dizziness, blurred vision or drowsiness.

A: If symptoms occur while driving, stop safely, cease driving and seek medical review.

A: Documented advice is recommended for workers in safety‑sensitive roles.

Usage Basics

INN, Brand Names Available In Australia

INN: chloroquine.

International brand names include Aralen, Nivaquine, Lariago and regional brands listed in global registers.

In Australia, chloroquine preparations are uncommon compared with hydroxychloroquine; always verify TGA ARTG listings and local pharmacy availability.

Table: Common International Brands And Strengths

Note: Verify TGA ARTG entries for exact names and packaging before ordering.

Legal Classification (TGA‑Approved, PBS‑Listed)

Chloroquine is generally Prescription Only (Rx).

Clinicians and pharmacists must check the TGA Australian Register of Therapeutic Goods (ARTG) for current approvals and the PBS for subsidy listings.

Hydroxychloroquine has largely replaced chloroquine in many rheumatology settings, and artemisinin‑based combinations are preferred for many malaria strains.

• Check the TGA ARTG for registration and approved indications.
• Confirm PBS listing and any special authority requirements before dispensing.
• Community pharmacists and major chains can assist with sourcing and PBS processes.

Dosing Guide

Standard Regimens (PBS Reference Dosing)

Standard adult dosing for acute malaria: 600 mg base initially, then 300 mg base at 6, 24 and 48 hours (total 1.5 g base).

Maintenance dosing for rheumatoid diseases: 250–500 mg daily in adults.

Paediatric acute malaria dosing is weight‑based: 10 mg/kg base initially, then 5 mg/kg base at 6, 24 and 48 hours.

Definition List:

• Base vs Salt: Prescribe using mg base for accuracy when local guidance requires base conversions.
• Conversion: Check local references for salt‑to‑base conversions before prescribing.

Adjustments For Comorbidities

Reduce dose or increase monitoring for people with hepatic or renal impairment, elderly patients and those with low body weight.

Avoid chloroquine in uncontrolled epilepsy and use caution when co‑prescribing QT‑prolonging drugs.

For long‑term therapy, schedule baseline and periodic ophthalmologic reviews and cardiac assessment with ECG.

Document weight, renal and hepatic function and adjust dosing accordingly.

Pre‑Treatment Assessment Checklist:

• Record weight and calculate weight‑based doses for children.
• Baseline ECG and LFTs, creatinine/eGFR.
• Baseline ophthalmology assessment for long‑term use.
• Medication review for interacting drugs.

Q&A — “What If I Miss A Dose?”

Q: What should I do if I miss a dose?

A: Take the missed dose as soon as you remember unless it is nearly time for the next scheduled dose.

A: Do not double up doses.

A: For acute malaria regimens, contact the prescriber or local clinic immediately if a dose is missed as this may affect effectiveness.

Interaction Chart

Food And Drinks (Alcohol, Coffee, Australian Diet Context)

Food does not materially alter chloroquine absorption, but taking it with food can reduce gastrointestinal irritation.

Alcohol may exacerbate liver injury and worsen dizziness; advise moderation or avoidance during therapy.

Caffeine‑rich drinks can mask symptoms like tremor or palpitations — counsel patients to monitor symptoms rather than rely on stimulant effects.

Patient Advice Sheet:

• Take with food if stomach upset occurs.
• Avoid heavy alcohol while on therapy.
• Report palpitations, dizziness or visual changes promptly.

Common Drug Conflicts

Key interactions include QT‑prolonging agents (for example macrolide antibiotics and some antipsychotics), drugs that lower seizure threshold (such as bupropion and tramadol), digoxin and hypoglycaemic agents.

Co‑prescription with QT‑prolonging drugs requires ECG monitoring and specialist input.

Interaction Table For Clinician Use

User Reports And Trends

Australian patient feedback from forums and review sites commonly highlights access and price concerns and a preference for pharmacist counselling.

Consumers frequently report nausea, itching, visual blurring and confusion over chloroquine versus hydroxychloroquine availability.

Rural and remote patients report delays in supply and reliance on telehealth and e‑scripts.

Top Five Consumer Concerns:

• Difficulty sourcing chloroquine locally and confusion with hydroxychloroquine.
• Cost and price sensitivity for long‑term therapy.
• Gastrointestinal side effects such as nausea.
• Concerns about vision changes and long‑term eye damage.
• Safety concerns following high‑profile off‑label use during COVID‑19.

Table Comparing Online Review Themes Versus Clinical Safety Data

Access And Purchase Options

National Chains (Chemist Warehouse, Priceline, TerryWhite Chemmart)

Large chains can source TGA‑listed stock but may not routinely stock chloroquine on the shelf.

For chronic indications, repeat prescriptions via GP or specialist and PBS authority scripts may be needed.

Pharmacists should confirm availability and PBS status and offer counselling on adverse effects and storage.

• Check ARTG and PBS before ordering for the patient.
• Offer documented counselling and a patient information leaflet at supply.
• Arrange special authority paperwork when required for PBS subsidy.

Online Pharmacies And Telehealth E‑Prescriptions

E‑prescriptions via telehealth are accepted in Australia; always verify prescriber details and PBS entitlements before dispensing.

For rural Australians, mail‑order supply is an option but ensure secure packaging and documented counselling.

Warn patients against importing unverified international products — check ARTG, TGA import exceptions and pharmacy accreditation first.

Checklist For Safe Online Purchase:

• Verify prescriber identity and prescription validity.
• Check ARTG entry and PBS subsidy status where applicable.
• Confirm secure shipping and documented counselling on receipt.
• Do not use unverified international sources without TGA approval.

In our online pharmacy, chloroquine is available without a prescription, with discreet delivery to Australia in 9-21 days.

Mechanism And Pharmacology

Simplified Explanation

Chloroquine is an antiprotozoal and antimalarial (ATC P01BA01) that concentrates in parasite food vacuoles and interferes with haem detoxification, leading to parasite death.

It also has immunomodulatory effects that explain its use in some rheumatologic conditions.

Plain language for patients: it kills malaria parasites and can calm certain immune processes in autoimmune disease.

Quick Facts:

• Mechanism: Interferes with parasite haem metabolism and modulates immune activity.
• Onset: Clinical effects seen within days for malaria; immunomodulatory benefit may take weeks.
• Half‑Life: Long; accumulates in tissues.
• Tissue Accumulation: High distribution to tissues including eye and heart with long‑term use.

Clinical Terms

Oral chloroquine is well absorbed with a large volume of distribution and a long half‑life that predisposes to accumulation.

There is a narrow therapeutic index and life‑threatening overdose risks including cardiac arrhythmia, seizures and respiratory distress.

Clinicians should be aware of pharmacokinetic parameters and toxicity thresholds when prescribing and when managing overdose.

Indications And Off‑Label Uses

Approved Indications By TGA

Primary indications historically include acute malaria and some rheumatologic conditions such as SLE and rheumatoid arthritis, but confirm current TGA ARTG entries before prescribing.

In many regions hydroxychloroquine is preferred for rheumatology due to a better safety profile.

Off‑Label Uses In Australian Clinical Practice

Off‑label uses such as experimental antiviral therapy are not recommended outside clinical trials.

Following the COVID‑19 period, major agencies revoked emergency authorisations because of lack of reliable benefit and safety concerns.

Document informed consent and a clear risk/benefit discussion for any off‑label prescribing.

• Record indication, alternatives considered and reason for off‑label use.
• Obtain and document informed consent in the medical record.
• Arrange follow‑up monitoring and safety checks tailored to the off‑label use.

Key Clinical Findings

Recent Australian and international studies from 2022–2026 continue to show a reduced role for chloroquine as first‑line malaria therapy due to resistance in many regions.

Artemisinin‑based combinations are preferred for many malaria strains.

Clinical trials found no reliable benefit for COVID‑19 and identified increased cardiac risks in some cohorts, prompting regulatory warnings.

Evidence supports baseline and periodic retinal screening for long‑term use because of retinopathy risk.

Annotated References (for clinician follow‑up):

• Selection of major trials and regulatory safety statements summarised in clinical bibliographies (see ARTG and national guidance for originals).

Alternatives Matrix

PBS‑Listed Alternatives Comparison Table

Pros And Cons Checklist

Use this checklist as a decision aid during consultation.

• Efficacy in the specific species/strain or condition and local resistance patterns.
• Safety profile: cardiac and ocular risks with chloroquine versus hydroxychloroquine.
• Patient comorbidities including liver, kidney and seizure history.
• Cost and PBS subsidy availability.
• Pregnancy and breastfeeding considerations.

Flowchart: First‑Line Malaria Management For Australian Travellers

• Assess destination resistance pattern.
• If high chloroquine resistance, choose artemisinin‑based therapy.
• Consider primaquine for P. vivax with G6PD testing when indicated.
• Arrange follow‑up and access to treatment if symptoms persist.

Common Questions

These are FAQs gathered from routine Australian pharmacy consultations.

• Is it safe in pregnancy? Use only if clearly needed and after specialist review; check TGA guidance and document informed consent.
• Can I breastfeed? Discuss risks and benefits with the prescriber; monitor infant for adverse effects.
• What about common medicine interactions? Avoid QT‑prolonging drugs and seizure‑threshold‑lowering agents without specialist input; monitor ECG and symptoms.
• How should I store it? Store at room temperature (15–25°C) away from light and moisture and keep out of reach of children.
• What to do in overdose? Seek emergency care immediately and contact Poisons Information Australia on 13 11 26.
• When to seek urgent care? Sudden vision changes, palpitations, fainting, seizures or severe breathing difficulty require immediate emergency assessment.

Patient Handout Template:

• Medicine: chloroquine — reason for treatment, dosing schedule and expected duration.
• Key side effects to expect: nausea, headache, itch, blurred vision.
• Red flags: visual changes, palpitations, fainting, seizures — stop medication and seek urgent care.
• Follow‑up plan: baseline tests and scheduled reviews (ophthalmology, ECG where indicated).
• Emergency contact: Poisons Information Australia 13 11 26.

Price And Access Comparison Table

Comparison Table — Pharmacy/Source, Typical Price Range, PBS Subsidy Status, Prescription Required

Checklist For Patients Before Visiting Pharmacy:

• Bring GP or specialist script (paper or e‑prescription).
• Have PBS concession card if eligible for subsidy.
• Bring photo ID when requested by the pharmacy.

Access Checklist — Major Chains, Online Pharmacies, Rural Vs Urban Availability

• Confirm ARTG entry and registration status before ordering.
• Verify stock lead times and arrange mail delivery for remote patients.
• Document counselling and supply issues in the patient record.
• Arrange follow‑up appointments and monitoring as required.

Registration And Regulation

TGA Approval

Clinicians should check the TGA ARTG for current registration details, approved indications and sponsor information.

Historical approvals exist, but clinical practice has evolved and prescribers must align with current TGA guidance.

Step‑By‑Step Guide To Check ARTG:

1. Go to the TGA website and search the ARTG database for ‘chloroquine’.
2. Review the sponsor entry and approved indications listed for each ARTG item.
3. Check packaging and strength details to match the prescription exactly.

PBS Subsidy Details

Check the PBS website for current listings and any authority requirements for subsidy.

If a special authority is needed, complete the application with clinical justification and supporting documentation.

• Patients should check concession eligibility and have their cards ready.
• Pharmacies can assist in applying for authority and checking subsidy status.
• Document any out‑of‑pocket cost estimates for the patient before supply.

Storage And Handling

Household Storage In Australian Climate (Heat/Humidity)

Store chloroquine at controlled room temperature, ideally 15–25°C, protected from light and moisture.

In hot or humid Australian environments, keep the medicine in its original container in a cool, dry cupboard away from the bathroom or direct sunlight.

Keep all medicines out of reach of children; accidental ingestion of chloroquine can be fatal.

Household Safety Checklist:

• Store in original packaging at 15–25°C.
• Avoid bathroom or hot kitchen cupboards; choose a cool, dry location.
• Keep out of reach and sight of children.
• Return unused tablets to the pharmacy for safe disposal.
• Emergency numbers: Poisons Information Australia 13 11 26; local emergency services 000.

Cold‑Chain Handling For Pharmacies

Oral chloroquine forms do not require cold‑chain handling, but some injectable preparations or compounded syrups may have specific storage or transport instructions.

Pharmacies should follow TGA, manufacturer and PBS guidance for storage, expiry tracking and appropriate dispensing labels.

Checklist For Pharmacy SOP:

• Confirm manufacturer storage instructions for non‑oral forms.
• Track expiry dates and batch numbers on stock records.
• Label dispensed packs with clear storage and safety instructions.

Guidelines For Proper Use

Australian Pharmacist Counselling Style

Start consultations by confirming the indication and reviewing the dosing schedule, especially weight for paediatrics.

Discuss common side effects and emphasise red‑flag symptoms that require urgent review, such as visual changes, palpitations or seizures.

Review interactions and safe storage, and document consent for any off‑label use.

Provide written information including Poisons Information contact and emergency instructions.

Counselling Points:

• Confirm indication, dose and duration before supply.
• Discuss side effects: nausea, headache, itch, blurred vision.
• Highlight red flags and actions to take if they occur.
• Conduct a medication interaction check and advise about alcohol.

Sample Pharmacist Note Template:

• Date, patient name, medication, dose and duration.
• Summary of counselling points given and written information provided.
• Baseline tests advised (ECG, eye check, LFTs) and follow‑up plan.

Patient Advice From PBS And National Health Authorities

Follow PBS and TGA patient information leaflets where available and arrange baseline ophthalmology and ECG as indicated.

Report adverse events via the TGA Adverse Event System and return unused medication for safe disposal.

Follow‑Up Schedule Checklist:

• Baseline tests: ECG, visual assessment, LFTs and renal function as indicated.
• 3‑Month clinical review for tolerance and adherence.
• Annual eye check for patients on long‑term therapy.

Delivery Across Australia

Final Notes

Chloroquine remains an antimalarial and antiprotozoal listed under ATC P01BA01, with use declining where resistance exists and alternatives preferred in many settings.

Pharmacists should verify ARTG and PBS entries, screen for contraindications and interactions, and document counselling and consent for any off‑label use.

For overdose or urgent toxicity concerns, advise immediate emergency care and contacting Poisons Information Australia on 13 11 26.