- July 27, 2023
- By Dr. Sarah Thompson, PharmD
Hydroxychloroquine is generally prescribed in tablet form as an antimalarial and disease-modifying antirheumatic medicine used for conditions including rheumatoid arthritis and systemic lupus erythematosus, with Plaquenil representing the original brand and hydroxychloroquine sulfate serving as its active medicinal ingredient. Plaquenil is supplied as a 200 mg tablet containing 200 mg of hydroxychloroquine sulfate, equivalent to 155 mg of hydroxychloroquine base. A 400 mg daily dose is commonly achieved with two 200 mg tablets rather than a separate 400 mg Plaquenil tablet, depending on the condition and prescribed treatment schedule.
Generic versions contain the same 200 mg strength of hydroxychloroquine sulfate and are available from several manufacturers. In Canada, Health Canada lists Plaquenil alongside approved or marketed products from companies including Accord Healthcare and Angita Pharma, while other generic versions have also been authorized under the same active-ingredient group. These products may differ in tablet appearance, coating, markings, and non-medicinal ingredients, while maintaining the prescribed hydroxychloroquine strength. Brand Plaquenil and approved generic versions remain prescription medicines and are dispensed according to the dose selected by the treating clinician.
How to use
The drug is taken only orally. Each dose should be taken with a meal or with a glass of milk. After ingestion, it is rapidly and completely absorbed.
- Malaria prevention and treatment
Prevention of acute attacks of malaria is recommended 2 weeks in advance of potential contact. If the medication cannot be taken in advance, then the initial dose can be doubled. It is split into two doses and administered at a 6-hour interval. Preventive treatment should be continued for 8 weeks after leaving the endemic area. The prevention dosage is prescribed by the doctor based on the weight. If the individual is sick, the prevention dosage is typically doubled.
- Rheumatoid arthritis treatment
The cumulative effects of hydroxychloroquine are present. While adverse effects can develop quite quickly, the medication’s healing impact can take several weeks to become apparent. Hydroxychloroquine should be stopped if the patient’s condition does not significantly improve within six months after starting the treatment. As with the previous case, the medication should be prescribed by the doctor who will calculate not only the right dosage and treatment plan but will also be able to weigh all the benefits and risks.
Why Is Hydroxychloroquine More Affordable in Canada?
Hydroxychloroquine may be available at a lower price in Canada largely because several manufacturers compete in the 200 mg tablet market. Health Canada currently lists the original brand Plaquenil along with generic hydroxychloroquine products from Apotex, JAMP Pharma, Mint Pharmaceuticals, Sanis Health, Nora Pharma, and other companies. A Canadian pharmacy can therefore have access to more than one approved version of hydroxychloroquine rather than relying on a single brand.
Generic competition is an important part of the price difference. Health Canada requires an approved generic hydroxychloroquine product to contain the same medicinal ingredient in the same amount as its Canadian reference product and to demonstrate bioequivalence. The tablet may have different markings, coatings, colours, or non-medicinal ingredients, while the approved therapeutic standard remains the same.
The final price of hydroxychloroquine in Canada can also reflect provincial drug-plan policies, wholesale and retail markups, dispensing fees, and the particular version selected by the pharmacy. The Patented Medicine Prices Review Board regulates patented medicines at the manufacturer level, but it does not directly regulate prices of non-patented generic drugs.
For hydroxychloroquine, the amount paid at a Canadian pharmacy can therefore differ depending on whether Plaquenil or a generic version is supplied, the number of 200 mg tablets dispensed, and the pharmacy’s own dispensing charges.
How Much Does Plaquenil Cost in Canada?
Plaquenil 200 mg is available in Canada in both brand-name and generic versions. At a Canadian pharmacy, a 100-tablet supply of brand Plaquenil may cost about $70, while 200 tablets may cost about $135. Generic versions are typically listed at lower prices, with 60 tablets costing about $27, 120 tablets about $55, and 180 tablets about $82.
| Product | Strength | Quantity | Price | Price per Tablet |
|---|---|---|---|---|
| Generic Version | 200 mg | 60 tablets | About $27 | About $0.45 |
| Generic Version | 200 mg | 120 tablets | About $55 | About $0.46 |
| Generic Version | 200 mg | 180 tablets | About $82 | About $0.46 |
| Plaquenil | 200 mg | 100 tablets | About $70 | About $0.70 |
| Plaquenil | 200 mg | 200 tablets | About $135 | About $0.68 |
Is There a Limit on How Many Hydroxychloroquine Tablets Can Be Ordered at One Time?
The number of Plaquenil tablets supplied at one time is generally based on the quantity authorized by the prescription and the dispensing rules followed by the Canadian pharmacy. Plaquenil is commonly supplied as 200 mg tablets, so a prescription may cover 30, 60, 90, 100, or a larger number of tablets depending on the prescribed daily dose and length of treatment. Long-term treatment for lupus or rheumatoid arthritis can involve repeat prescriptions or refills instead of a single unusually large order.
For orders shipped from Canada to the United States, U.S. import rules are also relevant. The FDA states that personal importation of prescription medicines from another country is generally restricted. In limited circumstances where its personal-importation policy may apply, the quantity is generally expected to be no more than a three-month supply and documentation of medical use may be requested. FDA guidance also explains that this policy does not create an automatic right to import medication.
Hydroxychloroquine Uses in Covid
Coronavirus is an acute viral disease characterized by a predominant lesion of the respiratory system and the gastrointestinal tract. In severe cases, people may need intensive care, including mechanical ventilation.
After the first rumors about the effectiveness of Hydroxychloroquine against COVID-19 appeared, doctors in several countries immediately began prescribing the drug. In India, for example, it was also used for prevention. Healthy people did not lag behind and began to buy packs of unsafe medicine. Considering the panic and number of death the pandemic has caused and the fact that there was no known treatment, it can be understandable that people tried every possible way to save lives.
Meanwhile, there were numerous studies, based on which Hydroxychloroquine is not recommended for use by WHO and FDA. Data obtained to date cannot yet be considered sufficient for the use of Hydroxychloroquine in the treatment of patients with COVID-19 in routine practice. This drug is characterized by a large number of potential interactions with drugs prescribed to COVID-19 patients.
Moreover, the use of this antimalarial drug slows down the normalization of the inflammatory response of the body and lengthens the time of patients’ stay in the hospital. As studies have shown, the side effects and even deaths overweight any potential benefit. HHC should not be used in the treatment of COVID-19.
Contraindications and precautions
This medication should not be prescribed to individuals who have hypersensitivity to Hydroxychloroquine and to 4-aminoquinoline derivatives or to other components of the drug. Retinopathy (including a history of maculopathy) is also a contraindication. Children under 6 years of age should not take this medication. If long-term treatment is necessary, children have an increased risk of developing toxic effects. As with many medications, women who are pregnant should not use the drug.
Individuals with visual disorders should be aware that this medication can cause adverse ophthalmic reactions (risk of progression of retinopathy and visual disorders). Individuals with the following health problems should take the medication with caution:
- hematological diseases;
- neurological diseases;
- late stages of cutaneous porphyria and psoriasis (risk of worsening), simultaneous administration of drugs that can cause skin reactions;
- renal failure and/or liver failure, hepatitis, simultaneous administration of drugs that can adversely affect the function of the liver and/or kidneys;
- deficiency of glucose-6-phosphate dehydrogenase;
- gastrointestinal diseases;
- hypersensitivity to quinine (the possibility of cross-allergic reactions);
- conduction disorder of the heart and hypertrophy of both ventricles;
- cardiomyopathy.
Due to the risk of hypoglycemia, the drug should be administered with caution to patients both taking and not taking hypoglycemic drugs.
Side effects of Plaquenil Generic
When using this medication, the digestive system can suffer, which might result in diarrhea, stomach cramps, nausea, and other side effects. Individuals may become irritable and may experience mania, psychosis, hallucinations, paranoid or suicidal thoughts, and other disturbances.
As the dosage increases, the risk of retinopathy increases, which is damage to the retina that can lead to blindness. To calculate the risk of retinopathy, doctors even came up with a special calculator, according to which doses of more than 5 mg per kilogram of body weight should be taken with caution.
In rare cases, severe and sometimes deadly, skin lesions, as well as hematopoietic disorders, are possible. Also, potentially lethal consequences of using the drug can be a prolongation of the QT interval of the heart and cardiomyopathy.
Overdose
The symptoms of an overdose include cardiotoxicity. With chronic intoxication, hypertrophy of the myocardium of both ventricles is likely. Other overdose symptoms include decreased blood pressure, neurotoxicity (headache, dizziness, irritability, convulsions, coma), visual impairment, and respiratory and cardiac arrest. Overdose is especially dangerous for young children, even taking 1 to 2 g of the drug can be fatal.
Treatment consists of gastric lavage, prescription of medications that reduce the metabolic load on the organs of excretion and detoxification, forced diuresis and alkalinization of urine to increase the excretion of 4-aminoquinoline in the urine, symptomatic therapy, and maintenance of vital functions. It is necessary to control the concentration of sodium in the blood serum and constant medical supervision for at least 6 hours after the relief of symptoms.