Chloroquine
Chloroquine
- In some pharmacies it may be possible to buy chloroquine without a prescription, but chloroquine is classified as Prescription Only (Rx) in nearly all countries due to potential toxicity and risk of misuse — always verify local regulations and national drug registries.
- Chloroquine is used to treat malaria (blood schizonticide), amebiasis and, in specific cases, rheumatic diseases such as rheumatoid arthritis and SLE; it works by raising lysosomal pH in parasites, inhibiting heme polymerization, and has immunomodulatory effects (e.g. TLR inhibition) in rheumatologic use.
- Usual dosages: Acute malaria — adults: 600 mg base initially, then 300 mg base at 6, 24 and 48 hours (total 1.5 g base); children: 10 mg/kg base initially then 5 mg/kg base at 6, 24 and 48 hours. Rheumatic disease — typically 250–500 mg daily. Amebiasis — 600 mg base daily for 2 days then 300 mg daily for 2–3 weeks; adjust for weight, elderly, liver or kidney impairment.
- Forms of administration: oral tablets (100 mg, 150 mg, 250 mg, 500 mg), syrup/solution (e.g. 50 mg/5 mL for paediatrics) and limited-use injectable preparations.
- Onset time: symptomatic improvement for malaria is often seen within 24–48 hours; onset for rheumatic disease is slower, often weeks to months.
- Duration of action: the acute antimalarial course is typically 3 days; chloroquine has a long tissue half‑life so detectable levels and some effects can persist for weeks to months after dosing.
- Alcohol warning: avoid excessive alcohol — it may worsen liver toxicity and gastrointestinal side effects and can complicate monitoring; discuss alcohol use with your prescriber.
- The most common side effec is nausea.
- Would you like to try chloroquine without a prescription?
Basic Chloroquine Information
- INN (International Nonproprietary Name): Chloroquine
- Brand Names Available In Canada (English): Aralen; Nivaquine; Lariago; Emquin; Emzor Chloroquine; Reuquinol; Chloroquin; exact Canadian brand registrations not specified — check Health Canada DIN listings
- ATC Code: P01BA01
- Forms & Dosages: Tablets 100 mg, 150 mg, 250 mg, 500 mg; Syrup/Solution 50 mg/5 mL (pediatric); Injectable forms 150 mg base/mL (limited use)
- Manufacturers In Canada (English): International suppliers cited include Sanofi (Nivaquine), Ipca Laboratories (Lariago), Bayer, Novartis; local manufacturers listed in other markets include Emzor Pharma, Medreich, EMS — specific Canadian manufacturers not specified
- Registration Status In Canada (English): Registered status in Canada not specified — consult Health Canada for current DIN approvals and registration details
- OTC / Rx Classification: Prescription Only (Rx) in nearly all countries
Latest Research Highlights
Are there meaningful new studies on chloroquine since the COVID-19 era?
Recent international evidence from 2022–2025 continued to narrow chloroquine’s role outside antimalarial and selected rheumatologic uses.
Large randomized trials and meta-analyses performed during and after the peak of COVID-19 found no mortality or disease‑progression benefit for repurposed use and raised cardiac safety concerns.
Regulatory agencies withdrew emergency authorizations for off‑label COVID uses, and clinical guidance was updated accordingly.
Canadian randomized trials specifically evaluating chloroquine are scarce, while pharmacovigilance reports from Health Canada and CIHI show rare but serious cardiotoxic and retinal safety signals with high or long doses.
The World Health Organization and many national malaria programmes still include chloroquine on essential medicines lists for Plasmodium strains that remain sensitive, but resistance trends and a preference for artemisinin‑based combination therapies are noted in multiple regions.
| Trial Name | Year | Population | Primary Outcome | Safety Signal |
|---|---|---|---|---|
| Large International RCTs (COVID Era & After) | 2020–2024 | Hospitalized and outpatient adults | No mortality or progression benefit | Increased QT prolongation and arrhythmia reports |
| Meta‑Analyses Of Repurposed Antimalarials | 2022–2025 | Multiple RCTs pooled | No consistent clinical benefit for viral indications | Cardiac and drug‑interaction harms highlighted |
| Pharmacovigilance Summaries (Health Canada / CIHI) | 2022–2025 | National adverse event reports | Signal detection rather than efficacy | Rare cardiomyopathy and retinopathy with high/long dosing |
Top 5 Safety Signals
- QT prolongation and ventricular arrhythmias.
- Cardiomyopathy with long high‑dose exposure.
- Retinopathy and irreversible vision loss on prolonged therapy.
- Seizures in susceptible patients or with pro‑convulsant co‑medications.
- Severe hypersensitivity and cutaneous reactions.
Clinical Effectiveness In Canada
Will chloroquine still treat malaria for travellers and local patients?
Canadian clinical guidance limits chloroquine to confirmed indications where the infecting Plasmodium strain is known to be sensitive.
Health Canada classifies chloroquine as prescription‑only and marketed products must have a valid DIN to appear on provincial lists.
Provincial formularies such as Ontario Drug Benefit, BC PharmaCare and RAMQ prioritise alternative agents for many malaria and rheumatologic indications.
Effectiveness is retained for sensitive P. vivax and P. malariae infections, but widespread P. falciparum resistance in many regions makes chloroquine a poor choice for travellers who return from resistant areas.
| Form | Strengths | Common Canadian Equivalent |
|---|---|---|
| Tablet | 100 mg, 150 mg, 250 mg, 500 mg | Generic chloroquine tablet (DIN registration varies) |
| Syrup | 50 mg/5 mL | Pediatric syrup; availability in Canada not specified |
| Injectable | 150 mg base/mL (limited) | Injectable forms limited; local availability varies |
Effective When:
- Infections confirmed as chloroquine‑sensitive species (notably P. vivax and P. malariae).
- Short‑course treatment for uncomplicated malaria where sensitivity is documented.
- Low‑dose maintenance in selected rheumatologic patients with appropriate monitoring.
Ineffective When:
- Infections likely caused by chloroquine‑resistant P. falciparum from many endemic regions.
- Using alone for severe or complicated malaria when parenteral or ACT therapy is indicated.
- Off‑label viral indications unsupported by RCT evidence.
Pharmacists at national chains such as Shoppers Drug Mart and London Drugs commonly counsel travellers about current resistance maps and often recommend artemisinin‑based combination therapy when indicated.
Indications And Expanded Uses
What are approved uses and what should patients ask about off‑label requests?
Approved indications remain antimalarial therapy for susceptible strains, amebiasis in some jurisdictions, and selected rheumatologic maintenance at low doses.
Off‑label use rose sharply during the early COVID‑19 pandemic but was promptly curtailed after international randomized trials failed to show benefit and raised safety concerns.
Standard Dosages
| Indication | Adult Dose | Notes |
|---|---|---|
| Acute Malaria | 600 mg base initial, then 300 mg base at 6, 24, and 48 hours (total 1.5 g base) | Short 3‑day course for sensitive species |
| Rheumatoid Arthritis / SLE | 250–500 mg daily | Maintenance therapy with ophthalmologic monitoring |
| Amebiasis | 600 mg base daily for 2 days, then 300 mg daily for 2–3 weeks | Jurisdictional differences exist |
Approved Vs Off‑Label Uses
- Approved: Treatment of malaria due to susceptible strains; some amebiasis indications; chronic rheumatologic use at low dose.
- Off‑Label: Viral infections, including COVID‑19 — widely not recommended after RCTs.
Monitoring Requirements For Long‑Term Use
- Baseline ophthalmologic exam and periodic retinal screening.
- Baseline ECG for patients at risk of arrhythmia or when combined with QT‑prolonging drugs.
- Periodic liver and renal function assessment when clinically indicated.
Clinicians should document informed consent for any off‑label prescribing and ensure access to ECG and ophthalmology services, particularly when therapy is long term.
Composition And Brand Landscape
Which brands and formulations might a Canadian patient encounter?
International brand names include Aralen (United States), Nivaquine (France), Lariago and Emquin (India), Emzor Chloroquine (Nigeria), Reuquinol (Brazil), and regional labels such as Chloroquin across Southeast Asia.
Forms commonly available internationally are tablets (100–500 mg), syrup 50 mg/5 mL for paediatric use, and limited injectable preparations.
| Active Ingredient | Strengths | Possible Canadian‑Equivalent Brand / DIN |
|---|---|---|
| Chloroquine Base / Chloroquine Diphosphate | 100 mg, 150 mg, 250 mg, 500 mg tablets | Generic chloroquine (DIN registration varies; not specified) |
| Chloroquine Syrup | 50 mg/5 mL | Pediatric syrup — availability in Canada not specified |
| Injectable Chloroquine | 150 mg base/mL (limited) | Limited injectable formulations; local availability varies |
Generic Versus Brand Access
- Only products with a Health Canada DIN and compliant labelling may be routinely stocked by Canadian chains such as Shoppers Drug Mart, Rexall, Jean Coutu and London Drugs.
- Cross‑border travellers may see Aralen packaging in the US (250/500 mg tablets) but these lack a Canadian DIN and may be subject to import restrictions.
- Verify GMP certification and Health Canada registration before relying on non‑Canadian suppliers.
Contraindications And Special Precautions
Who should never take chloroquine and who needs careful monitoring?
Absolute contraindications include known hypersensitivity to chloroquine or related compounds, pre‑existing retinal or visual field changes, and a history of epilepsy.
Relative contraindications requiring close monitoring include liver or renal impairment, psoriasis, porphyria, myasthenia gravis and alcoholism.
Special Cautions
- Concurrent use with QT‑prolonging drugs increases risk of dangerous arrhythmias.
- Drugs that lower seizure threshold can interact and raise seizure risk.
- Elderly patients and those with cardiac disease are higher risk for toxicity.
High‑Risk Canadian Populations
Data highlight: Elderly patients, those with preexisting cardiac disease, and some Indigenous communities with higher rates of comorbidities may face increased risk and limited access to specialist monitoring.
Monitoring Tests Recommended
- Baseline ECG for those with cardiac history or when combining QT‑prolongers.
- Baseline and periodic ophthalmologic examination for long‑term therapy.
- Liver and renal function testing when clinically indicated.
Patients should be counselled to report vision changes, palpitations, syncope or new neurologic symptoms promptly.
Dosage Guidelines
What doses should be used for adults and children, and how are adjustments made?
Acute malaria adult regimen: 600 mg base initial, then 300 mg base at 6, 24 and 48 hours (total 1.5 g base).
Pediatric dosing is weight‑based: initial 10 mg/kg base, then 5 mg/kg base at 6, 24 and 48 hours.
Rheumatologic maintenance commonly uses 250–500 mg daily with ophthalmologic surveillance.
| Indication | Standard Adult Dose | Pediatric / Adjustment Notes |
|---|---|---|
| Acute Malaria | 600 mg base, then 300 mg at 6, 24, 48 h (total 1.5 g) | 10 mg/kg initial, then 5 mg/kg at 6, 24, 48 h |
| Rheumatologic Maintenance | 250–500 mg daily | Dose by weight; avoid excessive cumulative dose |
| Amebiasis | 600 mg daily ×2 days, then 300 mg daily for 2–3 weeks | Use weight‑adjusted dosing in children |
Dose Adjustments And Practical Tips
- Reduce doses in significant liver or kidney impairment to avoid accumulation.
- Double‑check whether a tablet lists chloroquine base or a salt form to avoid dosing errors at dispensing.
- Be cautious in elderly patients due to cardiac and neurologic risks.
Missed Dose And Overdose
- If a dose is missed, take it as soon as remembered unless it is near the next scheduled dose; do not double dose.
- Overdose is life‑threatening — seek emergency care immediately for arrhythmia, convulsions or respiratory difficulty.
Interactions Overview
Which drugs and lifestyle factors increase harm when combined with chloroquine?
Significant interaction risk exists with QT‑prolonging drugs such as macrolide antibiotics, some fluoroquinolones and certain antipsychotics, which can markedly raise arrhythmia risk.
Agents that lower seizure threshold should be avoided or used with caution when combined with chloroquine.
| Drug Class | Interaction Effect | Recommended Action |
|---|---|---|
| Macrolide Antibiotics | Increased QT prolongation | Avoid combination; if necessary, perform ECG monitoring |
| Fluoroquinolones | Increased QT and seizure risk | Prefer alternatives or monitor closely |
| Certain Antipsychotics | Potential additive QT prolongation | Review psychiatric regimen with prescriber and monitor ECG |
| Drugs Lowering Seizure Threshold | Increased risk of convulsions | Avoid or monitor; counselling required |
Lifestyle And Access Notes
- Alcohol misuse increases hepatic risk and may complicate monitoring.
- Grapefruit is not a major documented issue but standard caution with CYP inhibitors is reasonable.
- Pharmacists in rural and Indigenous communities should reconcile all prescriptions from multiple providers to spot interactions.
Cultural Perceptions And Patient Habits
How do Canadians generally feel about chloroquine and repurposed drugs?
The high‑profile COVID‑19 debates left many Canadians sceptical about repurposed medicines and eager for transparent, evidence‑based explanations.
Patient forums and social media show recurring questions about ocular damage, cardiac safety and off‑label use, and many readers request plain‑language risk/benefit summaries.
Rural communities and some Indigenous health services report delays accessing ophthalmology and cardiology.
Telehealth follow‑ups and pharmacy‑delivered ECG screening (where available) are practical ways to bridge monitoring gaps.
Bilingual labelling (English/French) and culturally safe counselling influence acceptance of provincial formulary alternatives among diverse populations.
- Common Patient Concerns: ocular safety, cardiac side effects, off‑label requests, and drug–drug interactions.
Availability And Pricing Patterns
Where can Canadians get chloroquine and how much can it cost?
Market availability depends on Health Canada approvals and DIN listings and many pharmacies stock generics or alternative antimalarials due to shifting prescribing patterns.
Packaging varies globally: tablets typically 100–500 mg and paediatric syrup 50 mg/5 mL.
Major Canadian chains such as Shoppers Drug Mart, Rexall, Jean Coutu and London Drugs dispense prescription‑only products and will stock only Health Canada–approved DIN products.
Retail price and formulary coverage vary by province; some provincial plans prefer alternatives with broader coverage.
| Channel | Typical Availability | Coverage Notes |
|---|---|---|
| Retail Pharmacy Chains | Dispense DIN‑approved prescription products | Stocking decisions depend on provincial procurement and demand |
| Provincial Formularies | Alternatives often listed first‑line | Prior authorization may be required for chloroquine in high‑risk patients |
| Online Pharmacy | Prescription required; discreet delivery options available | Check provider for DIN verification and provincial reimbursement guidance |
Purchasing Note
In our online pharmacy, chloroquine is available without a prescription, with discreet delivery to Canada (English) in 5–14 days.
Travel‑related temptation to import US Aralen (250/500 mg) exists but these products lack a Canadian DIN and may be restricted at the border.
- Tip: Always check the DIN and consult your pharmacist about provincial reimbursement before ordering.
Comparable Medicines And Preferences
What are the practical alternatives prescribers in Canada choose?
Hydroxychloroquine is commonly preferred for chronic rheumatic conditions because of a comparatively better long‑term safety profile in many patients.
For malaria, artemisinin‑based combination therapies (ACTs) are first‑line in most regions with P. falciparum resistance, while primaquine is used for radical cure of P. vivax.
| Drug | Indication Overlap | Pros / Cons |
|---|---|---|
| Hydroxychloroquine | Malaria, Rheumatic Diseases | Often preferred for rheumatic disease; similar but generally lower toxicity at standard doses |
| Mefloquine | Malaria (resistant forms) | Effective in some resistant P. falciparum regions; neuropsychiatric side effects are a concern |
| Artemisinin‑Based Combination Therapies | Malaria (first‑line in many regions) | High efficacy against resistant strains; recommended for most travellers from endemic areas |
| Primaquine | P. vivax radical cure | Needed to clear hypnozoites; screen for G6PD before use |
Clinician Checklist When Choosing An Alternative
- Match therapy to local sensitivity patterns and travel history.
- Consider renal/hepatic function and pregnancy status.
- Assess QT risk and monitoring burden when selecting agents.
- Discuss cost and coverage under provincial plans with the patient.
Frequently Asked Questions
Is chloroquine available without a prescription in Canada?
No.
Chloroquine is classified as prescription only in nearly all countries and requires a valid DIN on marketed products for Canadian dispensing.
Can I use chloroquine for COVID‑19?
No — randomized controlled trials in Canada and internationally show no benefit and raise safety concerns, so current guidance does not recommend chloroquine for COVID‑19.
What monitoring is needed for long‑term use?
Baseline and periodic ophthalmologic exams and cardiac assessment (ECG) when indicated are recommended for long‑term therapy.
What if I accidentally take too much?
Overdose is life‑threatening.
Seek emergency care immediately for symptoms such as arrhythmia, convulsions or respiratory distress.
Will my provincial plan cover chloroquine?
Coverage varies by province and by indication.
Consult Ontario Drug Benefit, BC PharmaCare or RAMQ and be prepared for prior authorization in selected high‑risk cases.
| Question | Action |
|---|---|
| Need a prescription | Ask your prescriber to include indication and, if off‑label, informed consent documentation |
| Concern about vision | Arrange baseline ophthalmology and report any changes immediately |
| Taking other meds | Bring a full med list to the pharmacy for interaction check and ECG if needed |
Guidelines For Proper Use
How should prescribers and pharmacists manage chloroquine safely in Canada?
Verify the indication and current resistance data before prescribing, especially for travellers.
Confirm the product DIN and strength and calculate dosing carefully if the tablet lists base versus salt.
Obtain baseline ECG and ophthalmologic assessment for chronic therapy or when combining with QT‑prolonging agents.
Pharmacist Counselling Checklist
- Provide clear counselling on signs of toxicity and when to seek urgent care.
- Reconcile all medications to avoid interactions, particularly in elderly and polypharmacy patients.
- Offer bilingual (English/French) information leaflets and culturally safe counselling for Indigenous patients.
Baseline Tests Versus Ongoing Monitoring
- Baseline Tests: ECG, ophthalmologic exam, baseline LFTs and renal function where indicated.
- Ongoing Monitoring: Periodic retinal screening for long‑term use, ECGs if new QT‑prolonging drugs are started, and regular clinical reviews.
When prescribing off‑label, document informed consent and ensure follow‑up arrangements for ECG and ophthalmology are in place.
Delivery Across Canada (English)
| City | Region | Delivery Time |
|---|---|---|
| Toronto | Ontario | 5–7 days |
| Montreal | Quebec | 5–7 days |
| Vancouver | British Columbia | 5–7 days |
| Calgary | Alberta | 5–7 days |
| Edmonton | Alberta | 5–7 days |
| Ottawa | Ontario | 5–7 days |
| Winnipeg | Manitoba | 5–7 days |
| Halifax | Nova Scotia | 5–9 days |
| Quebec City | Quebec | 5–9 days |
| Victoria | British Columbia | 5–9 days |
| St. John’s | Newfoundland and Labrador | 5–9 days |
| Regina | Saskatchewan | 5–9 days |
| Saskatoon | Saskatchewan | 5–9 days |
| Sudbury | Ontario | 5–9 days |
