Hydroxychloroquine Alternatives: What to Try Instead and When

Hydroxychloroquine (HCQ) is used for malaria, lupus, and rheumatoid arthritis. People look for alternatives when HCQ causes side effects, isn’t effective, or is hard to get. Below I list common options by condition and give simple safety tips so you know what to ask your prescriber.

Alternatives by condition

Malaria: Modern malaria care usually uses artemisinin-based combination therapies (ACTs) as first-line treatment in many countries. Other options include atovaquone-proguanil, doxycycline (often for prevention), and mefloquine when appropriate. Choice depends on the malaria strain, local resistance patterns, and whether treatment is for prevention or active infection.

Lupus and rheumatoid arthritis (chronic autoimmune care): HCQ is popular because it works well for some patients and has a mild side-effect profile. If HCQ isn’t right for you, doctors commonly consider:

• Immunomodulators: methotrexate or azathioprine — used to reduce autoimmune activity.
• Antimalarial alternatives in some cases: chloroquine (less used) or switching drug class entirely.
• Biologic therapies: TNF inhibitors, belimumab (for lupus), and other targeted biologics for specific autoimmune patterns.
• Mycophenolate mofetil: often used for more severe organ involvement in lupus.

Each of these has different side effects and monitoring needs. For example, methotrexate can affect the liver and needs blood tests; biologics raise infection risk and usually require screening before starting.

Choosing the right alternative and staying safe

There’s no one-size-fits-all answer. Start by telling your doctor why HCQ isn’t an option — side effects, poor response, or supply issues. Ask which drug matches your condition, what tests you’ll need, and how soon you should expect improvement.

Safety checklist to discuss with your provider:

• Planned monitoring: eye exams, blood tests, liver checks, or infection screening depending on the drug.
• Drug interactions: list all prescription and over-the-counter medicines you take.
• Pregnancy and breastfeeding plans — some drugs aren’t safe in pregnancy.
• Cost and access: ask about cheaper generics, patient assistance, or safe online pharmacy options if needed.

If you’re considering an online purchase, use licensed pharmacies and check local rules on importing medications. Always verify a prescription and keep copies of lab results and treatment plans. If a new symptom appears after switching drugs, contact your clinician right away.

Want help preparing questions for your doctor? I can draft a short checklist you can bring to the appointment, including what labs to request and what side effects to watch for.