Hydroxychloroquine Alternatives: What to Try and When

Stopped taking hydroxychloroquine or looking for other options? Good — there are solid choices depending on why you used it. Hydroxychloroquine is used for malaria and autoimmune conditions (like lupus and rheumatoid arthritis). The safest replacement depends on your diagnosis, past side effects, and future pregnancy plans. Below I lay out practical alternatives and what you need to watch for.

Alternatives by condition

For malaria prevention or treatment: atovaquone‑proguanil (Malarone), doxycycline, and mefloquine are commonly used. Each has pros and cons: doxycycline is cheap and effective but causes sun sensitivity and isn’t usually used in young children or some pregnant people; atovaquone‑proguanil is well tolerated but costlier; mefloquine works well in many places but can cause sleep or mood changes for some people. Your travel destination and medical history determine the best choice.

For autoimmune diseases (lupus, rheumatoid arthritis): doctors often switch to other disease‑modifying drugs. Methotrexate and sulfasalazine are staples for rheumatoid arthritis. Azathioprine and mycophenolate mofetil are used more for lupus or when stronger immune suppression is needed. Biologic drugs — like TNF inhibitors or B‑cell blockers — are options when conventional meds don’t control disease. Some people also use quinacrine in combination with other antimalarials when hydroxychloroquine isn’t an option.

How to pick the right option and stay safe

Start by asking: what was hydroxychloroquine treating, and why stop it? If it was for eye toxicity risk or interactions, your doctor will weigh alternatives with different monitoring needs. For example, methotrexate needs regular liver tests and a folic acid supplement; azathioprine often requires TPMT enzyme testing before starting; biologics usually require screening for latent infections like TB and close infection monitoring.

Know common side effects so you’re not surprised. Antibiotics for malaria can cause stomach upset or photosensitivity. Immunosuppressants raise infection risk and can affect blood counts and liver tests. Talk about contraception and pregnancy plans — some drugs aren’t safe in pregnancy and require planning.

Practical tips: bring a short list of your meds and past reactions to appointments, ask which monitoring tests you’ll need and how often, and check whether your insurance or pharmacy covers the alternative. If you travel, tell the clinician where you’re going so they can pick the best anti‑malarial.

If you’re unsure, ask for a clear plan: what to expect in the first 3 months, warning signs to call about, and when to repeat labs or eye exams. Changing medication is common — the goal is good disease control with the fewest side effects. Talk openly with your clinician and get a follow‑up visit scheduled after the switch.