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Copyright ©The Author(s) 2025.
World J Biol Chem. Jun 5, 2025; 16(2): 107042
Published online Jun 5, 2025. doi: 10.4331/wjbc.v16.i2.107042
Table 1 Clinically relevant drug interactions with chloroquine and hydroxychloroquine
Interacting drug/class
Mechanism of interaction
Clinical implication
Recommendation
Proton pump inhibitors Reduce lysosomal acidification, affecting HCQ accumulationDecreased therapeutic efficacyConsider dose separation or switching to H2 antagonists
DigoxinInhibition of P-glycoprotein leads to increased digoxin levelsRisk of digoxin toxicityMonitor serum digoxin levels
MethotrexateOverlapping immunosuppression, altered metabolismPotential increased toxicityMonitor hepatic and hematologic parameters
TamoxifenAdditive risk of retinopathyIncreased ocular toxicityOphthalmologic monitoring if used long-term
Antacids (e.g., magnesium/aluminum)Interfere with GI absorption of CQ/HCQReduced drug bioavailabilitySeparate doses by at least 4 hours
QT-prolonging agents (e.g., azithromycin, amiodarone)Additive risk of QT prolongationIncreased risk of arrhythmiasBaseline and follow-up ECG monitoring
Cytochrome P450 inhibitors (e.g., ketoconazole)Impaired metabolism of CQ/HCQElevated plasma drug concentrationsDose adjustment and monitoring for toxicity
Insulin and antidiabetic agentsHCQ enhances insulin sensitivity and lowers blood glucoseRisk of hypoglycemiaMonitor blood glucose closely