Dosage Application

Chloroquine can be given orally, intravenously, subcutaneously, and intramuscularly. Parenteral application leads to very high plasma concentrations (mean±SD plasma concentration after 3 mg/kg intramuscularly, 265±149 |g/l; orally, 54±122 |g/l). They are accompanied by unwanted and sometimes dangerous side effects.

A chloroquine daily oral dose of 250 mg leads to therapeutic plasma concentrations not before 3 weeks owing to the long plasma half-life. It was recommended to give a single dose of 1 g initially in adults, that is, four tablets of chloroquine. In our experience, this approach can lead to misunderstanding and an involuntary overdose (Ochsendorf and Runne 1991). Higher doses initially, such 2x 250mg/day for 4 weeks, often lead to unspecific side effects, such as nausea or stomach problems. Therefore, the patient may not accept this effective therapeutic concept any longer. It is recommended that higher doses be used only for a short period if at all. Short-term higher doses, as in malaria prophylaxis, seem to be safe with respect to retinopathy.

Quinacrine is given orally. Doses of 100mg/day (one tablet) should not be exceeded. If optimal effects are achieved (3 to 6 months), the dose should be tapered 1 day a week every 2 months until maintenance doses of one to three tablets a week are reached. If diarrhea or other adverse reactions occur, the daily dose can be reduced to 25-50 mg. The time until a clinically apparent benefit occurs is approximately 2-3 months with this low dose (Wallace 1989).

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