Hydroxychloroquine alternatives: practical options for different conditions
Hydroxychloroquine has been used for malaria, lupus, and rheumatoid arthritis for years. But it isn't always the best or safest choice for every person. You might need an alternative because of side effects, drug interactions, shortages, or simply because your disease isn’t controlled. Here’s a short, useful guide to common substitutes and when they’re used.
Alternatives for autoimmune diseases (lupus, rheumatoid arthritis)
If hydroxychloroquine isn’t working or causes problems, doctors often turn to these drugs. Methotrexate is a go-to for rheumatoid arthritis. It’s strong, cheap, and works for many people, but it requires blood tests and avoids pregnancy. Sulfasalazine and leflunomide are other oral options that can be combined with methotrexate or used alone.
For lupus, especially when organs are involved, azathioprine or mycophenolate mofetil are common choices. Mycophenolate is often preferred for lupus nephritis. Biologic drugs—like TNF inhibitors (etanercept, adalimumab) or targeted agents such as belimumab—are options when standard drugs fail. Biologics need specialist approval and monitoring, but they can work where other meds don’t.
Topical problems (skin lupus, rashes) can sometimes be managed with topical corticosteroids or calcineurin inhibitors (tacrolimus) instead of adding another systemic medicine. Always discuss fertility, pregnancy, and breastfeeding with your specialist before switching.
Alternatives for malaria and travel medicine
For malaria prevention or treatment, choices depend on where you’re travelling. Artemisinin-based combination therapies (like artemether-lumefantrine) are the mainstay for treating falciparum malaria in many regions. For prevention, atovaquone-proguanil (Malarone), doxycycline, and mefloquine are commonly prescribed. Each has pros and cons: doxycycline is cheap but causes sun sensitivity; mefloquine can cause vivid dreams or mood changes; atovaquone-proguanil is well tolerated but pricier.
Resistance patterns differ by country. Always check up-to-date travel health advice (CDC or local travel clinic) before picking a drug. Pregnant travelers need special advice—many antimalarials are not safe in pregnancy.
One more note: hydroxychloroquine is not an effective COVID-19 treatment based on current evidence. If you’re looking for COVID care, ask your doctor about approved antivirals or monoclonal antibodies where applicable.
How to choose? Match the drug to your condition, medical history, and lifestyle. Consider monitoring needs (blood tests, liver checks, pregnancy plans) and known side effects. Talk to your specialist or pharmacist—bring your list of current meds and any heart, liver, or kidney issues. A careful switch can keep you safe and keep symptoms under control without guesswork.
