Hydroxychloroquine alternatives: Which option fits your condition?

Looking for hydroxychloroquine alternatives? The right substitute depends on why you take it. Doctors prescribe hydroxychloroquine (HCQ) for malaria prevention/treatment and long-term autoimmune care (lupus, rheumatoid arthritis). It also made headlines during the COVID-19 pandemic, but evidence didn’t back it for that use. Below you’ll find clear alternatives by condition, plus practical tips for talking with your clinician and managing safety and cost.

Alternatives by condition

Autoimmune diseases (lupus, RA): HCQ is favoured for mild disease and its safety profile, but other options work depending on symptoms. Common choices include methotrexate (often for RA), sulfasalazine, azathioprine, and mycophenolate mofetil. For more severe or resistant disease, biologic drugs—like TNF inhibitors (etanercept, adalimumab) or targeted agents (belimumab for lupus)—are effective. Corticosteroids control flares quickly but aren’t ideal long-term due to side effects. Each drug comes with different monitoring needs and infection risks, so plan follow-up with blood tests and vaccinations.

Malaria prevention and treatment: Modern malaria care normally uses artemisinin-based combination therapies (ACTs) where effective. Other options include atovaquone–proguanil (Malarone), mefloquine, doxycycline, or chloroquine in regions where the parasite is still sensitive. Your travel destination, pregnancy status, and drug tolerability determine which one’s best. Always check current travel health advice for resistance patterns before you pick a drug.

COVID-19 and other viral infections: HCQ isn’t recommended for treating or preventing COVID-19 based on large trials. If you have COVID-19, follow current treatment guidelines—these may include antivirals like nirmatrelvir/ritonavir (Paxlovid) or remdesivir for certain patients, plus supportive care. Talk to your provider about approved therapies rather than off-label choices.

How to choose and stay safe

Ask these questions: Why are you switching? What are the main risks and monitoring tests? How quickly does the new drug work? Will it affect vaccines or pregnancy? If cost matters, ask about generics or patient assistance programs. For autoimmune drugs, expect baseline labs and periodic checks: liver tests and blood counts for methotrexate, TPMT testing for azathioprine, infection screening for biologics.

Side effects differ. HCQ needs regular eye exams for rare retinal damage. Methotrexate can irritate the liver and lungs; azathioprine might lower white blood cells; biologics increase infection risk. Know the warning signs—fever, severe cough, yellowing of skin, or sudden vision changes—and report them promptly.

Finally, pharmacies and cost: many alternatives are prescription-only. Compare prices, ask about generics, and use reputable pharmacies. If you buy online, choose one with verified credentials and clear contact info. Insurance prior authorization is common for biologics—get help from your clinic’s pharmacy team if needed.

Switching a medication is a partnership between you and your provider. Bring a list of current meds, allergies, and specific concerns to your appointment. With the right plan, you can find an alternative that controls symptoms and fits your life.