Hydroxychloroquine Alternatives: What Works and When to Use Them

If you’ve heard a lot about hydroxychloroquine lately, you probably wonder if there are other drugs that can do the same job. Whether you need something for lupus, rheumatoid arthritis, or malaria, you’re not stuck with one pill. Below we break down the most common alternatives, how they compare, and what to watch out for.

First off, hydroxychloroquine is a derivative of chloroquine, an old‑school malaria drug. It’s also used for autoimmune conditions because it calms down the immune system. The good news is that several newer and older meds target the same pathways, often with fewer side effects. But each alternative fits a specific condition, so picking the right one matters.

Autoimmune Alternatives: Lupus and Rheumatoid Arthritis

If you take hydroxychloroquine for lupus or rheumatoid arthritis, you have three solid backup choices. Belimumab (Benlysta) is a biologic that specifically blocks a protein called BLyS, which fuels lupus activity. It’s given as an IV infusion once a month, and many patients report fewer flares than with hydroxychloroquine alone.

Another option is methotrexate. Though originally a cancer drug, low‑dose methotrexate is a staple for rheumatoid arthritis. It works by slowing down the rapid cell growth that fuels joint inflammation. You’ll need regular blood tests, but the drug is cheap and widely available.

For those who can’t tolerate pills, infliximab (Remicade) offers a different approach. It’s an anti‑TNF antibody that blocks a key inflammatory signal. Given as an infusion every six to eight weeks, it’s powerful for severe cases. Side‑effects include infection risk, so doctors keep a close eye on you.

Malaria and Tick‑Borne Disease Alternatives

When it comes to malaria, the classic alternative is artemether‑lumefantrine (Coartem). This combination kills the parasite at a different stage than chloroquine, making it effective against resistant strains. It’s taken twice daily for three days and works well for both travelers and residents in high‑risk areas.

Another malaria option is atovaquone‑proguanil (Malarone). It’s a single‑tablet regimen taken daily for the duration of exposure. Many people prefer it because it has fewer side‑effects like nausea and dizziness compared to older drugs.

If you need treatment for tick‑borne diseases such as babesiosis, azithromycin combined with atovaquone is a proven combo. It’s not a direct hydroxychloroquine swap, but it tackles the same intracellular parasite in a similar way.

Before switching, always talk to your doctor. Blood tests, kidney function checks, and a review of other meds are essential steps. The right alternative depends on the condition you’re treating, how your body reacts, and what other health issues you have.

Bottom line: hydroxychloroquine has several reliable stand‑ins, from biologics for autoimmune disease to modern antimalarials for travel. Knowing your options helps you stay in control of your health, no matter why you started on hydroxychloroquine in the first place.