Aralen (chloroquine): Possible Treatment for COVID-19

What is Aralen (chloroquine), and how does it work (mechanism of action)?

Chloroquine (Aralen) and its sister drug hydroxychloroquine (Plaquenil) are under investigation for treatment of the COVID-19 coronavirus disease
Korean doctors used these anti-malaria drugs to treat COVID-19 with some success, according to a paper filed with Elsevier in March 2020. A tiny French study also suggested the drugs might reduce duration of coronavirus symptoms, but effectiveness is unproven.

Chloroquine, brand name Aralen, is an anti-malarial drug. It is similar to hydroxychloroquine (Plaquenil), and is useful in treating several forms of malaria as well as amebiasis that has spread outside of the intestines. Its mechanism of action is unknown; however, malarial parasites invade human red blood cells, and chloroquine may prevent malarial parasites from breaking down (metabolizing) hemoglobin in human red blood cells. Chloroquine is effective against the malarial parasites Plasmodium vivax, P. malariae, P. ovale, and susceptible strains of P. falciparum.

Is Aralen available as a generic drug?

Yes, chloroquine is available in generic form.

What are the uses for Aralen?

Aralen is used for treating:

Acute attacks of
malaria due
to P. vivax, P. malariae, P. ovale, and susceptible
strains of
P. falciparum
Extraintestinal amebiasis

Aralen is not effective for malaria prevention.
It suppresses malaria infection, stops acute attacks, and lengthens the time between treatment and relapse.

It's off-label use (non-FDA approved use) is for the treatment of
porphyria cutanea tarda.

What are the side effects of Aralen?

Common side effects include

Irreversible damage to the retina
Deafness
Tinnitus (ringing in the ears)
Reduced hearing
Increased liver enzymes
Anorexia
Nausea
Vomiting
Diarrhea

Other, rare side effects

Possible serious effects

Personality changes
Depression
Hypotension
Polyneuritis
Extrapyramidal disorders
Psychosis
Pancytopenia
Aplastic anemia
Thrombocytopenia
Serious allergic reactions
Muscle damage (myopathy)
Hepatitis
Maculopathy and macular degeneration

Other adverse reactions and side effects of Aralen

There have been rare reports of severe skin reactions such as erythema
multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and
exfoliative dermatitis.
Chloroquine may precipitate a severe attack of
psoriasis in patients with
psoriasis and may worsen porphyria. Chloroquine should not be used in these
conditions unless the benefit to the patient outweighs the potential risks.
People with retinal or visual field changes should not use chloroquine unless
it is absolutely necessary.
Some strains of
P. falciparum are resistant to chloroquine and
hydroxychloroquine. Chloroquine resistance is widespread.
Chloroquine should not be used for treatment of P. falciparum infections from
areas of chloroquine resistance or malaria occurring in patients where
chloroquine prophylaxis has failed.
Patients infected with a resistant strains of plasmodia should be treated
with another antimalarial drug.
Retinopathy, maculopathy, irreversible retinal damage, as well as macular
degeneration have been reported. Retinopathy from chloroquine may be dose
related. Initial and periodic eye examinations are recommended during prolonged
treatment. Chloroquine should be discontinued immediately if there are changes
in vision.
Chloroquine may cause acute extrapyramidal disorders (abnormal,
uncontrollable body movements) that usually resolve after treatment is stopped.
Patients should be observed for evidence of muscular
weakness. If weakness
occurs treatment should be stopped.
Fatalities have occurred in children from accidental ingestion of small doses
of chloroquine. Chloroquine should be kept out of the reach of children.

What is the dosage for this Aralen?

For acute malaria attacks in adults the initial dose is 1 g followed by an
additional 500 mg after 6 to 8 hours, then 500 mg 24 and 48 hours after the
first dose.
The dose for treating children is 10 mg/kg for the first dose then 5 mg/kg
daily for 2 days, starting 6 hours after the first dose.
The dose for treating intestinal amebiasis is 1 g daily for two days, followed
by 500 mg daily for at least two to three weeks.

Chloroquine usually is combined
with an effective intestinal amebicide.

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Which drugs or supplements interact with this medication?

Antacids and kaolin can reduce absorption of chloroquine. Administration of
this drug and these agents should be separated by at least 4 hours.
Cimetidine (Tagamet) can block the breakdown of chloroquine, increasing its
blood levels. This combination should be avoided.
Chloroquine significantly reduces blood levels of ampicillin. Ingestion of
ampicillin and chloroquine should be separated by at least two hours.
Chloroquine may increase cyclosporine blood levels. Cyclosporine blood levels
should be monitored and, if necessary, chloroquine should be stopped.
Combining chloroquine and mefloquine may increase the risk of seizures.
Chloroquine can reduce the antibody response to primary immunization with
intradermal human diploid-cell rabies vaccine.

Is this drug safe to use during pregnancy or while breastfeeding?

There are no studies evaluating the safety and efficacy of chloroquine in
during pregnancy. If you are pregnant this drug should be
avoided unless it is necessary and the benefit outweighs the risk.
Chloroquine is excreted in breast milk.

What else should I know about this medication?

This drug is available as 250mg and 500 mg tablets.
Keep this medication stored at room temperature, between 15-30 C (59-86 F).
The FDA approved chloroquine in October 1949.