Hydroxychloroquine alternatives: practical choices for malaria and autoimmune care

If hydroxychloroquine isn’t right for you — because of side effects, interactions, or supply problems — there are clear alternatives depending on why you take it. Below I break down real drug options, how they differ, and what to watch for so you can have a focused conversation with your clinician.

Alternatives for malaria prevention and treatment

For travel or treatment of malaria, the main alternatives are:

Atovaquone-proguanil (Malarone) — Often a first choice for short trips. It works quickly, has fewer neuropsychiatric side effects than some drugs, and is usually well tolerated. Downsides: cost and the need to start a day before travel.

Doxycycline — Cheap and effective for many regions. It’s started one day before travel and continued after return. Watch for sun sensitivity (easy sunburn) and avoid in pregnancy and young children.

Mefloquine — Good in some high-risk areas, but can cause vivid dreams, anxiety, or worse in people with psychiatric history. Not ideal if you’ve had mood issues before.

Artemisinin-based treatments — Standard for malaria treatment in many countries; used mainly for active infections rather than routine prevention.

Choice depends on destination, local resistance patterns, health history, and pregnancy status. Always check current travel advisories and ask your prescriber for region-specific advice.

Alternatives for lupus and rheumatoid arthritis (autoimmune use)

If you take hydroxychloroquine for lupus or RA, several other medication classes can help control disease or flare risk:

Immunomodulators — Methotrexate and azathioprine are common next-steps. They reduce immune activity more strongly than hydroxychloroquine and need routine blood tests to watch liver function and blood counts.

Sulfasalazine — Often used in RA and sometimes combined with other drugs. It’s usually tolerable but can cause digestive upset or rash in some people.

Biologics and targeted therapies — Drugs like belimumab (for lupus) or TNF inhibitors (for RA) target specific immune molecules. They can be very effective but raise infection risk and are more expensive.

Short-term steroids — Prednisone can control flares quickly but isn’t a long-term strategy due to side effects when used chronically.

Which option fits you? That depends on how active your disease is, past medication response, pregnancy plans, and how willing you are to accept monitoring and potential risks.

Quick practical tips: always tell your doctor about other meds, pregnancy, or mood disorders; ask about monitoring schedules when a new drug is started; and get a clear plan for what to do if side effects appear. If you’re considering alternatives because of COVID-related reasons, discuss evidence with your clinician — hydroxychloroquine isn’t proven for COVID prevention or treatment, and other options won’t be either unless studied for that purpose.

Need a one-page summary for your doctor? Ask for a printed comparison of side effects, monitoring needs, and pregnancy safety for your top two choices before you switch.