Drug Interactions between hydroxychloroquine and telithromycin
This report displays the potential drug interactions for the following 2 drugs:
- hydroxychloroquine
- telithromycin
Interactions between your drugs
hydroxychloroquine telithromycin
Applies to: hydroxychloroquine and telithromycin
GENERALLY AVOID: Coadministration with strong CYP450 3A4 or 2D6 inhibitors may significantly increase the plasma concentration and effects of hydroxychloroquine (HCQ), which is partially metabolized by the isoenzymes. Following coadministration with cimetidine, a weak to moderate CYP450 3A4 inhibitor and weak CYP450 2D6 inhibitor, a 2-fold increase in chloroquine exposure occurred. Because chloroquine and hydroxychloroquine have similar structures and metabolic elimination pathways, a similar interaction could be observed for hydroxychloroquine. The risk of QT prolongation may be further increased with concomitant use of strong CYP450 3A4 inhibitors (e.g., ceritinib, clarithromycin, mifepristone, saquinavir, telithromycin, some azole antifungals) or strong CYP450 2D6 inhibitors (e.g., fluoxetine) that are also known to prolong the QT interval. No data are available for more potent CYP450 3A4 or 2D6 inhibitors that also prolong the QT interval.
MANAGEMENT: Coadministration of hydroxychloroquine with strong CYP450 3A4 or CYP450 2D6 inhibitors that can prolong the QT interval should generally be avoided, particularly in patients with baseline QT prolongation (e.g., QTc greater than or equal to 500 msec) or congenital long QT syndrome. If concomitant use is required and benefits are anticipated to outweigh the risks, close monitoring of the QTc interval, electrolyte levels, and renal and hepatic function is recommended, and the dose adjusted as necessary whenever strong CYP450 3A4 or 2D6 inhibitor is added to or withdrawn from therapy. Electrolyte abnormalities should be corrected prior to initiating treatment with hydroxychloroquine. Patients should be advised to seek immediate medical attention if they experience symptoms of torsades de pointes (e.g., dizziness, fainting, palpitations, irregular heart rhythm, or syncope) or symptoms of other serious hydroxychloroquine-related adverse effects such as severe cutaneous adverse drug reactions (SCARs), renal or liver toxicity, hematologic toxicities, myopathy or neuropathy, retinopathy, neuropsychiatric symptoms, gastrointestinal distress, hypoglycemia, or heart failure. Because hydroxychloroquine is eliminated slowly from the body (terminal half-life: 40-50 days), potential drug interactions may persist for several weeks to months after its discontinuation.
References (5)
- (2024) "Product Information. Hydroxychloroquine Sulfate (hydroxychloroquine)." Dr. Reddy's Laboratories Inc
- (2023) "Product Information. Plaquenil (hydroxychloroquine)." Sanofi-Aventis Canada Inc
- (2024) "Product Information. Quinoric (hydroxychloroquine)." Bristol Laboratories Ltd
- (2024) "Product Information. Hydroxychloroquine (GH) (hydroxychloroquine)." Generic Health Pty Ltd
- (2023) "Product Information. HIDROXICLOROQUINA RATIOPHARM (hidroxicloroquina)." RATIOPHARM ESPANA S.A.
Drug and food interactions
hydroxychloroquine food
Applies to: hydroxychloroquine
GENERALLY AVOID: Theoretically, grapefruit and grapefruit juice may increase the plasma concentrations of hydroxychloroquine or chloroquine and the risk of toxicities such as QT interval prolongation and ventricular arrhythmias. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruit. Following coadministration with cimetidine, a weak to moderate CYP450 3A4 inhibitor, a 2-fold increase in chloroquine exposure occurred. Since chloroquine and hydroxychloroquine have similar structures and metabolic elimination pathways, a similar interaction may be observed with hydroxychloroquine. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.
ADJUST DOSING INTERVAL: Administration with food or milk may reduce the incidence of hydroxychloroquine-related gastrointestinal adverse effects.
MANAGEMENT: Although clinical data are lacking, it may be advisable to avoid the consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract during hydroxychloroquine or chloroquine therapy. Hydroxychloroquine should be administered with food or milk to reduce the occurrence of gastrointestinal upset.
References (5)
- (2024) "Product Information. Hydroxychloroquine Sulfate (hydroxychloroquine)." Dr. Reddy's Laboratories Inc
- (2023) "Product Information. Plaquenil (hydroxychloroquine)." Sanofi-Aventis Canada Inc
- (2024) "Product Information. Quinoric (hydroxychloroquine)." Bristol Laboratories Ltd
- (2024) "Product Information. Hydroxychloroquine (GH) (hydroxychloroquine)." Generic Health Pty Ltd
- (2023) "Product Information. HIDROXICLOROQUINA RATIOPHARM (hidroxicloroquina)." RATIOPHARM ESPANA S.A.
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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