For many years, certain types of rheumatoid arthritis, including rheumatoid arthritis (RA), have been treated with hydroxychloroquine sulfate, a synthetic antimalarial medication developed from a 4-quinoline derivative [1]. While these dosages can block DNA or RNA ligand-induced TLR9 or 7 signaling, or chloroquine likewise has no discernible effect on intracellular pH [2].

The sulfuric acid stock market Quexian and its counterparts, the sulfuric acid stock market Quexian mean retracement TLR7 and 9 signals, are used to treat lupus [2].

Effects During Pregnancy and Lactation
◉ Summary of Use during Lactation
Infants exposed to hydroxychloroquine during breastfeeding receive only small amounts of the drug in breastmilk. In infants up to at least 1 year of age, careful follow-up found no adverse effects on growth, vision or hearing. International experts indicate that hydroxychloroquine is acceptable during breastfeeding.
When given once weekly for malaria prophylaxis, the amount of drug is not sufficient to harm the infant nor is the quantity sufficient to protect the child from malaria. Breastfeeding infants should receive the recommended dosages of hydroxychloroquine for malaria prophylaxis.
◉ Effects in Breastfed Infants
No adverse effects were reported in one 9-month-old breastfed infant whose mother was taking 310 mg hydroxychloroquine base daily for 6 weeks.
Five mothers took hydroxychloroquine 200 mg daily during pregnancy and breastfeeding, one for 30 months. Flash electroretinograms performed on the infants were normal.
Another group of investigators have reported numerous infants whose mother took hydroxychloroquine during pregnancy and were breastfed during maternal hydroxychloroquine use. An abstract reported 16 infants breastfed for 1 to 19 months and followed up at an average of 24 months (range 1 to 86 months) with no evidence of visual or hearing deficits. In a letter they reported 8 breastfed infants followed up at 1, 6 and 12 months of age who had normal growth and development and who had thorough, normal eye examinations at 1 and 12 months of age. In a case series, 13 mothers taking hydroxychloroquine sulfate 200 mg daily breastfed their infants for an average of 2.8 months (range 1 to 6 months). None had evidence of retinal, motor or growth abnormalities during 12 months of follow-up. The authors conclude that the benefits of breastfeeding outweigh the risk of hydroxychloroquine. It appears that the 8 infants reported in the letter were included among the 13 infants in the case series, but it is unclear whether the 16 infants reported in the abstract were part of the case series.
Thirty-three women who had been taking hydroxychloroquine for at least one year and exclusively breastfeeding had hydroxychloroquine milk levels determined over a 12-hour period. Two-thirds of the women were also taking a corticosteroid. Dosages ranged from 200 mg once every two days to 200 mg twice daily. Follow-up at 1 year of the infants did not find ocular toxicity or growth abnormalities.
In a cohort study, over a 10-year period 130 nursing mothers with a rheumatic disease took hydroxychloroquine during partial or exclusive breastfeeding. No mention was made of adverse effects in their infants.
A woman with nephrotic syndrome took hydroxychloroquine, cyclosporine, and prednisone during pregnancy and lactation. While breastfeeding she took hydroxychloroquine 200 mg, cyclosporine 125 mg in the morning and 100 mg at night (total of 3 mg/kg daily), daily and prednisone 30 mg daily. Her twin infants began partially breastfeeding (70 to 80% breastmilk) on day 7 postpartum and she continued to breastfeed for several months. The infants gained weight normally at one month of age and had no adverse reactions in the first three months postpartum.
A retrospective study was performed on data from patients with lupus erythematosus from 10 hospitals in the United Kingdom who received or did not receive hydroxychloroquine during pregnancy and lactation. One hundred fifty infants whose mothers took hydroxychloroquine during pregnancy and/or breastfeeding and were compared to 134 infants who were not exposed. Infants were followed for a median of 2.21 years. No differences in outcomes were seen between the two groups of infants, although the percentage of infants who were breastfed was not stated.
◉ Effects on Lactation and Breastmilk
A study of 43 women with systemic lupus erythematosus and their 57 pregnancies found that the use of hydroxychloroquine to treat the disease was associated with an increased duration of breastfeeding. Among mothers taking hydroxychloroquine, 88% breastfed for more than 6 months compared to 54% of women who did not take hydroxychloroquine.

[1]. Manzo C, et al. Psychomotor Agitation Following Treatment with Hydroxychloroquine. Drug Saf Case Rep. 2017 Dec;4(1):6.
[2]. Lamphier M, et al. Novel small molecule inhibitors of TLR7 and TLR9: mechanism of action and efficacy in vivo. Mol Pharmacol. 2014 Mar;85(3):429-40.
[3]. Yao X, et al. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis. 2020 Mar 9. pii: ciaa237

Hydroxychloroquine Sulfate is a synthetic derivative of quinolyl with chemotherapeutic and antibiotic properties, Hydroxychloroquine Sulfate acts against erythrocytic malarial parasites (Plasmodium vivax, ovale, and malariae) by concentrating in food vacuoles. It inhibits plasmodial heme polymerase and acts through other unknown mechanisms. Hydroxychloroquine also has anti-inflammatory properties and is used in the treatment of rheumatoid arthritis and lupus erythematosus. (NCI04)
A chemotherapeutic agent that acts against erythrocytic forms of malarial parasites. Hydroxychloroquine appears to concentrate in food vacuoles of affected protozoa. It inhibits plasmodial heme polymerase. (From Gilman et al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 9th ed, p970)
See also: Hydroxychloroquine (has active moiety).

C18H28CLN3O5S

433.948

433.143

747-36-4

Hydroxychloroquine;118-42-3;(S)-Hydroxychloroquine;137433-24-0;(R)-Hydroxychloroquine;137433-23-9;Hydroxychloroquine sulfate (Standard);747-36-4;Hydroxychloroquine-d4 sulfate;1854126-45-6

12947

White to off-white solid powder

516.7ºC at 760 mmHg

240 °C

266.3ºC

4.284

4

8

9

28

413

0

JCBIVZZPXRZKTI-UHFFFAOYSA-N

InChI=1S/C18H26ClN3O.H2O4S/c1-3-22(11-12-23)10-4-5-14(2)21-17-8-9-20-18-13-15(19)6-7-16(17)181-5(2,3)4/h6-9,13-14,23H,3-5,10-12H2,1-2H3,(H,20,21)(H2,1,2,3,4)

2-((4-((7-chloroquinolin-4-yl)amino)pentyl)(ethyl)amino)ethan-1-ol sulfate

Ercoquin Plaquinol Toremonil Oxychlorochin Oxychloroquine Plaquenil

2934.99.9001

Powder      -20°C    3 years

                     4°C     2 years

In solvent   -80°C    6 months

                  -20°C    1 month

Note: Please store this product in a sealed and protected environment (e.g. under nitrogen), avoid exposure to moisture and light.

Room temperature (This product is stable at ambient temperature for a few days during ordinary shipping and time spent in Customs)

H2O : ~110 mg/mL (~253.49 mM)
DMF : 1.4 mg/mL (~3.23 mM)
DMSO :< 1 mg/mL

Solubility in Formulation 1: 100 mg/mL (230.44 mM) in PBS (add these co-solvents sequentially from left to right, and one by one), clear solution; with sonication.

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 (Please use freshly prepared in vivo formulations for optimal results.)