The Basics
What is Hydroxychloroquine?
Antimalarial that works by killing the organisms that cause malaria. May work to treat rheumatoid arthritis and systemic lupus erythematosus.
Brand names for Hydroxychloroquine
Plaquenil
How Hydroxychloroquine is classified
Anti-infective Agents, Antiparasitic Agents, Antimalarials, Antirheumatic Agents, Antiprotozoal Agents
Hydroxychloroquine During Pregnancy
Hydroxychloroquine pregnancy category
Category Not AssignedNote 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 Hydroxychloroquine while pregnant
Human pregnancies resulting in live births have been reported in the literature and no increase in the rate of birth defects has been demonstrated. Embryonic deaths and malformations of anophthalmia and microphthalmia in the offspring have been reported when pregnant rats received large doses of chloroquine.
Taking Hydroxychloroquine While Breastfeeding
What are recommendations for lactation if you're taking Hydroxychloroquine?
Infants exposed to hydroxychloroquine during breastfeeding receive only small amounts of the drug in breastmilk. In a small number of infants up to at least 1 year of age, careful follow-up found no adverse effects on growth, vision or hearing.[1][2] International experts indicate that hydroxychloroquine is acceptable during breastfeeding.[3][4][5][6] When given once weekly for malaria prophylaxis, the amount of drug is not sufficient to harm the infant nor is the quantity sufficient to protect the child from malaria. Breastfeeding infants should receive the recommended dosages of hydroxychloroquine for malaria prophylaxis.[7]
Maternal / infant drug levels
Infants exposed to hydroxychloroquine during breastfeeding receive only small amounts of the drug in breastmilk. In a small number of infants up to at least 1 year of age, careful follow-up found no adverse effects on growth, vision or hearing.[1][2] International experts indicate that hydroxychloroquine is acceptable during breastfeeding.[3][4][5][6] When given once weekly for malaria prophylaxis, the amount of drug is not sufficient to harm the infant nor is the quantity sufficient to protect the child from malaria. Breastfeeding infants should receive the recommended dosages of hydroxychloroquine for malaria prophylaxis.[7]
Possible effects of Hydroxychloroquine on milk supply
Relevant published information was not found as of the revision date.
Possible alternatives to Hydroxychloroquine
(Rheumatoid Arthritis) Auranofin, Etanercept, Gold Sodium Thiomalate, Infliximab, Methotrexate, Penicillamine, Sulfasalazine.
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. Cimaz R, Brucato A, Meregalli E et al. Electroretinograms of children born to mothers treated with hydroxychloroquine during pregnancy and breast-feeding: comment on the article by Costedoat-Chalumeau et al. Arthritis Rheum. 2004;50:3056-7. PMID: 15457485
2. Motta M, Tincani A, Faden D et al. Follow-up of infants exposed to hydroxychloroquine given to mothers during pregnancy and lactation. J Perinatol. 2005;25:86-9. PMID: 15496869
3. Sammaritano LR, Bermas BL. Rheumatoid arthritis medications and lactation. Curr Opin Rheumatol. 2014;26:354-60. PMID: 24614280
4. Kavanaugh A, Cush JJ, Ahmed MS et al. Proceedings from the American College of Rheumatology Reproductive Health Summit: The management of fertility, pregnancy, and lactation in women with autoimmune and systemic inflammatory diseases. Arthritis Care Res (Hoboken). 2015;67:313-25. PMID: 25385050
5. Flint J, Panchal S, Hurrell A et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford). 2016;55:1693-7. PMID: 26750124
6. Gotestam Skorpen C, Hoeltzenbein M, Tincani A et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016;75:795-810. PMID: 26888948
7. Centers for Disease Control and Prevention. CDC Yellow Book 2018: Health Information for International Travel. New York: Oxford University Press. 2017. https://wwwnc.cdc.gov/travel/page/2018-yellow-book-about
8. Ostensen M, Brown ND, Chiang PK et al. Hydroxychloroquine in human breast milk. Eur J Clin Pharmacol. 1985;28:357. PMID: 4007043
9. Nation RL, Hackett LP, Dusci LJ et al. Excretion of hydroxychloroquine in human milk. Br J Clin Pharmacol. 1984;17:368-9. Letter.
10. Costedoat-Chalumeau N, Amoura Z, Aymard G et al. Evidence of transplacental passage of hydroxychloroquine in humans. Arthritis Rheum. 2002;46:1123-4. PMID: 11953993
11. Costedoat-Chalumeau N, Amoura Z, Sebbough D et al. Electroretinograms of children born to mothers treated with hydroxychloroquine during pregnancy and breast-feeding: comment on the article by Costedoat-Chalumeau et al. Author reply. Arthritis Rheum. 2004;50:3057-8. PMID: 15457485
12. Cissoko H, Rouger J, Zahr N, Darrouzain F, Jonville-Bera AP, Autret-Leca E. Breast milk concentrations of hydroxychloroquine. Fundam Clin Pharmacol. 2010;24 (Suppl 1):420. Abstract 420. DOI: doi:10.1111/j.1472-8206.2010.00819.x
13. Liu RJ, Zhang LJ, Mei D et al. Excretion of hydroxychloroquine in milk of lactating patients. Pharmacotherapy. 2016;36:E261. Abstract. DOI: doi:10.1002/phar.1877
14. Cimaz R, Brucato A, Meregalli E et al. Electroretinograms of children born from mothers treated with hydroxychloroquine (HCQ) during pregnancy and breast-feeding. Lupus 2004;13:755. Abstract. DOI: doi:10.1191/0961203304lu2014xx
15. Tincani A, Faden D, Lojacono A et al. Hydroxychloroquine in pregnant patients with rheumatic disease. Arthritis Rheum. 2001;44 (Suppl 9):S397. Abstract 2065. DOI: doi:10.1002/1529-0131(200109)44:9+<::AID-ART428>3.0.CO;2-1
16. Motta M, Tincani A, Faden D et al. Antimalarial agents in pregnancy. Lancet. 2002;359:524-5. PMID: 11853823
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.
