Hydroxychloroquine Sulfate and Imiquimod

• Generic Name: hydroxychloroquine
• Dosage Forms: n.a.
• Other Brand Names: Plaquenil, Quineprox

Prevention (prophylaxis) of malaria caused by Plasmodium malariae, P. ovale, chloroquine-susceptible P. vivax, and chloroquine-susceptible P. falciparum. Alternative when chloroquine is unavailable.

Treatment of uncomplicated malaria caused by P. malariae, P. ovale, chloroquine-susceptible P. vivax, or chloroquine-susceptible P. falciparum. Alternative when chloroquine is unavailable.

Do not use for prevention or treatment of malaria in areas where chloroquine resistance has been reported.

Active only against asexual erythrocytic forms of Plasmodium (not exoerythrocytic stages) and cannot prevent delayed primary attacks or relapse of P. ovale or P. vivax malaria or provide a radical cure; 14-day regimen of primaquine usually also indicated to eradicate hypnozoites and prevent relapse in patients exposed to or being treated for P. ovale or P. vivax malaria.

Information on risk of malaria in specific countries and mosquito avoidance measures and recommendations regarding whether prevention of malaria indicated and choice of antimalarials for prevention available from CDC.

Assistance with diagnosis or treatment of malaria available by contacting CDC Malaria Hotline at 770-488-7788 or 855-856-4713 from 9:00 a.m. to 5:00 p.m. Eastern Standard Time or CDC Emergency Operation Center at 770-488-7100 after hours and on weekends and holidays.

Rheumatoid Arthritis

Treatment of rheumatoid arthritis.

One of several disease-modifying antirheumatic drugs (DMARDs) that can be used when DMARD therapy is appropriate.

Consider risk of severe and sometimes irreversible toxicity if used for prolonged periods in treatment of rheumatoid arthritis.

Lupus Erythematosus

Treatment of discoid lupus erythematosus and systemic lupus erythematosus. Used as an adjunct to corticosteroids and/or other appropriate therapy.

Consider risk of severe and sometimes irreversible toxicity if used for prolonged periods in treatment of lupus erythematosus.

Q Fever

Treatment of Q fever endocarditis caused by Coxiella burnetii; used in conjunction with doxycycline.

CDC recommends a 2- to 3-week regimen of doxycycline for treatment of acute Q fever, a 1-year regimen of doxycycline and hydroxychloroquine for treatment of acute Q fever in patients with preexisting valvular heart disease (to prevent progression of acute disease to endocarditis), and a 1.5- to 3-year regimen of doxycycline and hydroxychloroquine for treatment of chronic Q fever.

Porphyria Cutanea Tarda and Polymorphous Light Eruptions

Has been used in treatment of porphyria cutanea tarda.

Has been effective in some cases when used in the treatment of polymorphous light eruptions.

• Generic Name: imiquimod topical
• Dosage Forms: n.a.
• Other Brand Names: Aldara, Zyclara, Zyclara Pump

Topical treatment of clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratosis on the face or scalp in immunocompetent adults.

Topical treatment of biopsy-confirmed, primary superficial basal cell carcinoma in immunocompetent adults. Safety and efficacy not established for other types of basal cell carcinoma, including nodular and morpheaform (fibrosing or sclerosing) types.

Use only when superficial basal cell carcinoma tumor diameter is ≤2 cm and is located on the trunk (excluding anogenital skin), neck, or extremities (excluding hands and feet).

Use only when surgical methods are medically less appropriate and patient follow-up can be reasonably assured.

Treatment of external genital and perianal exophytic warts (condylomata acuminata) caused by HPV in adults and adolescents ≥12 years of age.

CDC and others recommend that external HPV warts be treated with a self-administered topical therapy (imiquimod, podofilox), a topical therapy administered by a health-care provider (podophyllum resin, trichloroacetic acid [TCA], bichloroacetic acid [BCA]), or a surgical technique (cryotherapy, electrosurgery, surgical excision). Alternative therapies include intralesional interferon alfa or laser surgery.

A preferred treatment regimen for external genital HPV warts in HIV-infected adults and adolescents; data are limited regarding the response rate in HIV-infected patients compared with those without HIV infection. An alternative treatment regimen for external HPV warts in HIV-infected children; topical therapies often are ineffective in such children and a surgical technique (cryotherapy, electrosurgery) usually is preferred.

Primary goal is destruction or clearance of visible, symptomatic warts. No regimen has been shown to eradicate HPV or affect natural history of HPV infection; effect on transmission of HPV unknown.

Should not be used to treat subclinical genital HPV infection (without exophytic warts).

Safety and efficacy for treatment of urethral, intravaginal, cervical, rectal, or anal HPV warts not established. Some clinicians suggest use of topical imiquimod for treatment of distal meatal HPV warts, but data are limited.

Has been effective in a limited number of children, adolescents, and adults for the treatment of molluscum contagiosum, but safety and efficacy not established.

Clinical studies in children 2–12 years of age with molluscum contagiosum indicate imiquimod is no more effective than placebo.