The Basics
What is Chloroquine?
Used to prevent and treat malaria and amebiasis.
Brand names for Chloroquine
Aralen
How Chloroquine is classified
Anti-infective Agents, Antiparasitic Agents, Antimalarials, Antirheumatic Agents, Antiprotozoal Agents
Chloroquine During Pregnancy
Chloroquine pregnancy category
Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Chloroquine while pregnant
Radioactively tagged chloroquine administered intravenously to pregnant pigmented CBA mice passed rapidly across the placenta and accumulated selectively in the melanin structures of the fetal eyes. It was retained in the ocular tissues for five months after the drug had been eliminated from the rest of the body2. There are no adequate and well-controlled studies evaluating the safety and efficacy of chloroquine in pregnant women. Usage of chloroquine during pregnancy should be avoided except in the suppression or treatment of malaria when in the judgment of the physician the benefit outweighs the potential risk to the fetus.
Taking Chloroquine While Breastfeeding
What are recommendations for lactation if you're taking Chloroquine?
Very small amounts of chloroquine are excreted in breast milk; when given once weekly, the amount of drug is not sufficient to harm the infant nor is the quantity sufficient to protect the child from malaria. United Kingdom malaria treatment guidelines recommend that weekly chloroquine 500 mg be given until breastfeeding is completed and primaquine can be given.[1] Breastfeeding infants should receive the recommended dosages of chloroquine for malaria prophylaxis.[2] In HIV-infected women, elevated viral HIV loads in milk were decreased after treatment with chloroquine to a greater extent than other women who were treated with the combination of sulfadoxine and pyrimethamine.[3] Because no information is available on the daily use of chloroquine during breastfeeding, hydroxychloroquine or another agent may be preferred in this situation, especially while nursing a newborn or preterm infant.
Maternal / infant drug levels
Very small amounts of chloroquine are excreted in breast milk; when given once weekly, the amount of drug is not sufficient to harm the infant nor is the quantity sufficient to protect the child from malaria. United Kingdom malaria treatment guidelines recommend that weekly chloroquine 500 mg be given until breastfeeding is completed and primaquine can be given.[1] Breastfeeding infants should receive the recommended dosages of chloroquine for malaria prophylaxis.[2] In HIV-infected women, elevated viral HIV loads in milk were decreased after treatment with chloroquine to a greater extent than other women who were treated with the combination of sulfadoxine and pyrimethamine.[3] Because no information is available on the daily use of chloroquine during breastfeeding, hydroxychloroquine or another agent may be preferred in this situation, especially while nursing a newborn or preterm infant.
Possible effects of Chloroquine on milk supply
Relevant published information was not found as of the revision date.
Possible alternatives to Chloroquine
(Rheumatoid Arthritis) Auranofin, Etanercept, Gold Sodium Thiomalate, Hydroxychloroquine, Infliximab, Methotrexate, Penicillamine, Sulfasalazine; (Malaria) Atovaquone and Proguanil, Doxycycline, Mefloquine.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Lalloo DG, Shingadia D, Bell DJ et al. UK Malaria Treatment Guidelines 2016. J Infect. 2016. PMID: 26880088
2. Centers for Disease Control and Prevention. CDC Health Information for International Travel 2016. New York: Oxford University Press. 2016. wwwnc.cdc.gov/travel/page/yellowbook-home-2014
3. Semrau K, Kuhn L, Kasonde P et al. Impact of chloroquine on viral load in breast milk. Trop Med Int Health. 2006;11:800-3. PMID: 16772000
4. Deturmeny E, Viala A, Durand A et al. [Chloroquine transfer to milk. A case]. Therapie. 1984;39:438-40. Letter. PMID: 6484889
5. Witte AMC, Klever HJH, Brabin BJ et al. Field evaluation of the use of an ELISA to detect chloroquine and its metabolites in blood, urine and breast-milk. Trans R Soc Trop Med Hyg. 1990;84:521-5. PMID: 2091344
6. Edstein MD, Veenendaal JR, Newman K et al. Excretion of chloroquine, dapsone and pyrimethamine in human milk. Br J Clin Pharmacol. 1986;22:733-5. PMID: 3567020
7. Akintonwa A, Gbajumo SA, Biola Mabadeje AF. Placental and milk transfer of chloroquine in humans. Ther Drug Monit. 1988;10:147-9. PMID: 3381230
8. Ette EI, Essien EE, Ogonor JI et al. Chloroquine in human milk. J Clin Pharmacol. 1987;27:499-502. PMID: 3655001
9. Ogunbona FA, Onyeji CO, Bolaji OO et al. Excretion of chloroquine and desethylchloroquine in human milk. Br J Clin Pharmacol. 1987;23:473-6. PMID: 3580253
10. Boelaert JR, Yaro S, Augustijns P et al. Chloroquine accumulates in breast-milk cells: potential impact in the prophylaxis of postnatal mother-to-child transmission of HIV-1. AIDS. 2001;15:2205-7. Letter. PMID: 11684948
11. Law I, Ilett KF, Hackett LP et al. Transfer of chloroquine and desethylchloroquine across the placenta and into milk in Melanesian mothers. Br J Clin Pharmacol. 2008;65:674-9. PMID: 18279478
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
