Chloroquine Phosphate and Hydroxyprogesterone Caproate

• Generic Name: chloroquine
• Dosage Forms: n.a.
• Other Brand Names: Aralen Phosphate, Aralen Hydrochloride

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

Can be used for prevention of malaria in individuals traveling to malarious areas where chloroquine-resistant P. falciparum malaria has not been reported.

Risk of acquiring malaria varies substantially from traveler to traveler and from region to region (even within a single country) because of differences in intensity of malaria transmission within the various regions and season, itinerary, duration, and type of travel. Malaria transmission occurs in large areas of Africa, Central and South America, parts of the Caribbean, Asia (including South Asia, Southeast Asia, and the Middle East), Eastern Europe, and the South Pacific. Mosquito avoidance measures must be used in conjunction with prophylaxis since no drug is 100% effective in preventing malaria.

Choice of antimalarial for prophylaxis depends on traveler’s risk of acquiring malaria in area(s) visited, risk of exposure to drug-resistant P. falciparum, other medical conditions (e.g., pregnancy), cost, and potential adverse effects.

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; terminal prophylaxis with a 14-day regimen of primaquine may be indicated in addition to chloroquine prophylaxis if travelers were exposed in areas where P. ovale or P. vivax is endemic.

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 are available from CDC.

Treatment of Uncomplicated Malaria

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

For treatment of uncomplicated malaria caused by chloroquine-susceptible P. falciparum, P. malariae, or P. knowlesi or treatment of uncomplicated malaria when plasmodial species not identified and infection was acquired in areas where chloroquine resistance not reported, CDC recommends chloroquine (or hydroxychloroquine). Alternatively, CDC states that any of the regimens recommended for treatment of uncomplicated chloroquine-resistant P. falciparum malaria (fixed combination of atovaquone and proguanil [atovaquone/proguanil], fixed combination of artemether and lumefantrine [artemether/lumefantrine], regimen of quinine in conjunction with doxycycline, tetracycline, or clindamycin) may be used if preferred, more readily available, or more convenient.

Pediatric patients with uncomplicated malaria generally can receive same treatment regimens recommended for adults using age- and weight-appropriate drugs and dosages.

Because chloroquine active only against asexual erythrocytic forms of Plasmodium (not exoerythrocytic stages), 14-day regimen of primaquine indicated to eradicate hypnozoites and prevent delayed primary attacks or relapse and provide a radical cure whenever chloroquine used for treatment of P. ovale or P. vivax malaria.

Assistance with diagnosis or treatment of malaria available from 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.

Extraintestinal Amebiasis

Has been used for treatment of extraintestinal amebiasis (including liver abscess) caused by Entamoeba histolytica.

Ineffective for treatment of intestinal amebiasis.

A nitroimidazole derivative (metronidazole, tinidazole) followed by a luminal amebicide (iodoquinol, paromomycin, diloxanide furoate) is regimen of choice for mild to moderate or severe intestinal amebiasis and for amebic hepatic abscess.

Rheumatoid Arthritis

Has been used for treatment of rheumatoid arthritis.

When a disease-modifying antirheumatic drug (DMARD) indicated, other DMARDs (hydroxychloroquine, leflunomide, methotrexate, minocycline, sulfasalazine) recommended.

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

Lupus Erythematosus

Has been used as an adjunct to topical corticosteroid therapy in treatment of discoid lupus erythematosus and as an adjunct to systemic corticosteroid and/or salicylate therapy in treatment of systemic lupus erythematosus.

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

Porphyria Cutanea Tarda and Polymorphous Light Eruptions

Has been used with some success in treatment of porphyria cutanea tarda.

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

Sarcoidosis

Has been used with some success in the treatment of sarcoidosis.

• Generic Name: hydroxyprogesterone
• Dosage Forms: n.a.
• Other Brand Names: Makena, Makena Auto-Injector, Hylutin, Delta-Lutin, Duralutin, Hyprogesterone, Prodrox

Reduction of risk of preterm birth in women with a singleton pregnancy having a history of singleton spontaneous preterm birth (designated an orphan drug by FDA for this use).

Efficacy determined based on improvement in proportion of women who delivered at <37 weeks of gestation; direct clinical benefit (e.g., improvement in neonatal morbidity and mortality) not established.

Safety and efficacy demonstrated only in women with a prior spontaneous singleton birth; not intended for use in women with multiple gestations or other risk factors for preterm birth.

ACOG recommends offering progesterone supplementation for prevention of recurrent preterm birth to women with a singleton pregnancy and a prior spontaneous preterm birth at <37 weeks of gestation due to spontaneous preterm labor or premature rupture of membranes.