Hydroxychloroquine Alternatives: Options, Risks, and Practical Advice

Trying to find something that works instead of hydroxychloroquine? The right replacement depends on why you were taking it. Hydroxychloroquine is used for autoimmune illnesses like lupus and rheumatoid arthritis, and sometimes for malaria. Treatments that work for one use may not be right for another. Below are clear, practical alternatives with what to expect and what to ask your doctor.

Common drug alternatives and what they do

Methotrexate — A mainstay for rheumatoid arthritis and some autoimmune cases. It controls inflammation well, but you need regular blood tests because it can affect the liver and blood counts. Many people tolerate a weekly low dose; folic acid is often prescribed to reduce side effects.

Leflunomide — Works like methotrexate and is another disease‑modifying anti‑rheumatic drug (DMARD). It can be effective if methotrexate isn’t right for you. Expect monitoring for liver function and a long half‑life that can take weeks to clear.

Sulfasalazine — Often used in combination with other DMARDs. It helps joint and gut‑related autoimmune issues. Watch for rash and stomach upset. It’s a lower‑cost option for some patients.

Azathioprine — Used for lupus and other systemic autoimmune diseases. It suppresses the immune system more broadly, so infection risk and blood test monitoring are important. It may be chosen when other drugs fail or aren’t tolerated.

Biologic agents (TNF inhibitors, IL‑6 blockers, B‑cell therapies) — These target specific parts of the immune system and can work when oral DMARDs don’t. They often need screening for latent infections (like TB) before starting and come with higher costs and infection risk.

JAK inhibitors (tofacitinib and others) — Oral drugs that block certain immune signals. They can be effective quickly but carry risks like increased infection and blood clot signals in some groups. Your doctor will weigh risk vs benefit.

For malaria — Where hydroxychloroquine was used, modern choices include artemisinin‑based therapies, atovaquone‑proguanil, or doxycycline, depending on local resistance and travel destination. Use the regimen recommended for the region you’re visiting.

How to choose the right alternative

Ask these questions: What condition are we treating? What are the drug’s main risks? How often do I need blood tests? Is it safe if I’m pregnant or planning pregnancy? Will insurance cover it? Your age, other health issues, and pregnancy plans matter a lot.

Be honest about side effects you’ll tolerate. Some options need weekly dosing and lab checks; others require injections or infusions. If cost or monitoring is a problem, talk to your clinician about alternatives or patient support programs.

Final practical tip: don’t switch abruptly without medical guidance. Some drugs need tapering or overlap to avoid flares. If hydroxychloroquine isn’t working or causes side effects, bring a list of your symptoms and past drug trials to your appointment so your doctor can pick the best next step.