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A careful assessment of risks vs. Bedaquiline has been reported to prolong the QT interval. Prior to initiating bedaquiline, obtain serum electrolyte concentrations and a baseline electrocardiogram ECG. An ECG should also be performed at least 2, 12, and 24 weeks after starting bedaquiline therapy. Bepridil: Severe Bepridil administration is associated with a well-established risk of QT prolongation and torsades de pointes.

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Patients receiving other drugs which have the potential for QT prolongation, such as chloroquine, have an increased risk of developing proarrhythmias during bepridil therapy. Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: Major Potential QT prolongation has been reported in limited case reports with metronidazole. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with metronidazole include chloroquine. Bismuth Subsalicylate; Metronidazole; Tetracycline: Major Potential QT prolongation has been reported in limited case reports with metronidazole.

Botulinum Toxins: Major One study reported that chloroquine antagonized the actions of botulinum toxins e. The study suggested that chloroquine may prevent internalization by inhibiting toxin binding at the cell membrane or inhibit lysosomal processing of the toxin in the cell interior. Budesonide; Formoterol: Moderate Beta-agonists should be used cautiously and with close monitoring with chloroquine.

Bupivacaine Liposomal: Moderate Coadministration of bupivacaine with oxidizing agents, such as chloroquine, may increase the risk of developing methemoglobinemia.

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If methemoglobinemia occurs or is suspected, discontinue bupivacaine and any other oxidizing agents. Bupivacaine: Moderate Coadministration of bupivacaine with oxidizing agents, such as chloroquine, may increase the risk of developing methemoglobinemia. Bupivacaine; Lidocaine: Moderate Coadministration of bupivacaine with oxidizing agents, such as chloroquine, may increase the risk of developing methemoglobinemia. Moderate Coadministration of lidocaine with oxidizing agents, such as chloroquine, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue lidocaine and any other oxidizing agents.

Buprenorphine: Major Buprenorphine should be avoided in combination with chloroquine. Buprenorphine has also been associated with QT prolongation and has a possible risk of torsade de pointes TdP. FDA-approved labeling for some buprenorphine products recommend avoiding use with Class 1A and Class III antiarrhythmic medications while other labels recommend avoiding use with any drug that has the potential to prolong the QT interval.

If coadministration is necessary, carefully assess the risks versus benefits of concurrent use. Buprenorphine; Naloxone: Major Buprenorphine should be avoided in combination with chloroquine. Calcium Carbonate: Major Chloroquine absorption may be reduced by antacids. Major Chloroquine absorption may be reduced by antacids. Calcium Carbonate; Risedronate: Major Chloroquine absorption may be reduced by antacids. Calcium Carbonate; Simethicone: Major Chloroquine absorption may be reduced by antacids. Canagliflozin: Major Careful monitoring of blood glucose is recommended when chloroquine and antidiabetic agents, including the SGLT2 inhibitors, are coadministered.

Canagliflozin; Metformin: Major Careful monitoring of blood glucose is recommended when chloroquine and antidiabetic agents, including metformin, are coadministered. Major Careful monitoring of blood glucose is recommended when chloroquine and antidiabetic agents, including the SGLT2 inhibitors, are coadministered. Carbamazepine: Moderate Chloroquine may antagonize the activity of carbamazepine. Dose adjustments of carbamazepine may be required if chloroquine is added or removed from an existing carbamazepine regimen. Ceritinib: Major Avoid coadministration of ceritinib with chloroquine if possible due to the risk of QT prolongation.

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If concomitant use is unavoidable, periodically monitor ECGs and electrolytes; an interruption of ceritinib therapy, dose reduction, or discontinuation of therapy may be necessary if QT prolongation occurs. Concentration-dependent QT prolongation has also occurred with ceritinib treatment.

Chloroprocaine: Moderate Coadministration of chloroprocaine with oxidizing agents, such as chloroquine, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue chloroprocaine and any other oxidizing agents. Chlorpromazine: Major Coadminister chloroquine with other drugs known to prolong the QT interval, such as chlorpromazine, with caution. Chlorpromazine, a phenothiazine, is associated with an established risk of QT prolongation and TdP.

Chlorpropamide: Major Careful monitoring of blood glucose is recommended when chloroquine and antidiabetic agents, including the sulfonylureas, are coadministered. Cimetidine: Major Avoid concomitant use of chloroquine and cimetidine, Cimetidine can inhibit the metabolism and increase the serum concentrations of chloroquine. Ciprofloxacin: Major Due to an increased risk for QT prolongation and torsade de pointes TdP , caution is advised when administering chloroquine with ciprofloxacin. The need to coadminister chloroquine with other drugs associated with QT prolongation and TdP, such as ciprofloxacin, should be done with a careful assessment of risks versus benefits and should be avoided when possible.

Cisapride: Severe Coadministration of cisapride and chloroquine is contraindicated due to the risk for serious adverse events, such as QT prolongation and torsade de pointes TdP.

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QT prolongation and ventricular arrhythmias, including TdP and death, have been reported with cisapride. Chloroquine is also associated with an established risk of QT prolongation and TdP. Concurrent use may result in additive effects on the QT interval. Cisatracurium: Moderate Chloroquine may affect presynaptic and postsynaptic myoneural function and potentiate the neuromuscular blocking action of neuromuscular blockers. Citalopram: Major According to the manufacturer, concurrent use of citalopram with other drugs that prolong the QT interval, such as chloroquine, is not recommended.

If concurrent therapy is considered essential, ECG monitoring is recommended. Citalopram causes dose-dependent QT interval prolongation. Clarithromycin: Major Concurrent use of chloroquine and clarithromycin should be avoided due to an increased risk for QT prolongation and torsade de pointes TdP.

QT prolongation and torsade de pointes TdP have been reported in patients receiving clofazimine in combination with QT prolonging medications. Clomipramine: Major Coadminister chloroquine with other drugs known to prolong the QT interval, such as tricyclic antidepressants TCAs , with caution. Clozapine: Major Coadminister chloroquine with other drugs known to prolong the QT interval, such as clozapine, with caution.

Treatment with clozapine has been associated with QT prolongation, TdP, cardiac arrest, and sudden death. Cobimetinib: Moderate Concurrent use of chloroquine and cobimetinib is not recommended as there is an increased risk of retinal toxicity. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with promethazine include chloroquine. Crizotinib: Major Avoid coadministration of crizotinib with chloroquine due to the risk of QT prolongation.

An interruption of therapy, dose reduction, or discontinuation of therapy may be necessary for crizotinib patients if QT prolongation occurs. Crizotinib has been associated with concentration-dependent QT prolongation. Chloroquine is also associated with an increased risk of QT prolongation and torsade de pointes TdP ; fatalities have been reported. Cyclosporine: Major Close monitoring of serum cyclosporine concentrations is recommended during coadministration of chloroquine.

Sudden increases in cyclosporine concentrations have been reported after the addition of chloroquine. Discontinue chloroquine if necessary. Dapagliflozin: Major Careful monitoring of blood glucose is recommended when chloroquine and antidiabetic agents, including the SGLT2 inhibitors, are coadministered.

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Dapagliflozin; Metformin: Major Careful monitoring of blood glucose is recommended when chloroquine and antidiabetic agents, including metformin, are coadministered. Dapagliflozin; Saxagliptin: Major Careful monitoring of blood glucose is recommended when chloroquine and antidiabetic agents, including the dipeptidyl peptidase-4 inhibitors, are coadministered.

Dapsone: Moderate Coadministration of dapsone with chloroquine may increase the risk of developing methemoglobinemia. Advise patients to discontinue treatment and seek immediate medical attention with any signs or symptoms of methemoglobinemia. Dasatinib: Major Avoid coadministration of chloroquine with dasatinib if possible, due to the risk of QT prolongation and torsade de pointes TdP.

In vitro studies have shown that dasatinib has the potential to prolong cardiac ventricular repolarization prolong QT interval. Coadministration may further increase the risk of QT prolongation and torsade de pointes.

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Degarelix: Major Chloroquine administration is associated with an increased risk of QT prolongation and torsades de pointes TdP. If coadministration is necessary, use caution. Desflurane: Major Coadminister chloroquine with other drugs known to prolong the QT interval, such as halogenated anesthetics, with caution.

Halogenated anesthetics can prolong the QT interval. Desipramine: Major Coadminister chloroquine with other drugs known to prolong the QT interval, such as tricyclic antidepressants TCAs , with caution. Coadminister chloroquine with other drugs known to prolong the QT interval with caution. Clinically relevant QTc prolongation may occur with deutetrabenazine.

Dextromethorphan; Quinidine: Major Coadminister chloroquine with other drugs known to prolong the QT interval, such as quinidine, with caution. Quinidine administration is also associated with QT prolongation and TdP. Digoxin: Moderate Digoxin serum concentrations have been reported to increase when hydroxychloroquine was added. Although this interaction has not been reported with chloroquine in published literature, chloroquine may similarly increase the plasma concentration of digoxin.

For patients on a stable digoxin regimen and initiating chloroquine, no initial dose adjustment of either drug has been advised; however, serum digoxin concentrations should be monitored and used for digoxin dose titration as clinically necessary Dipeptidyl Peptidase-4 Inhibitors: Major Careful monitoring of blood glucose is recommended when chloroquine and antidiabetic agents, including the dipeptidyl peptidase-4 inhibitors, are coadministered. Disopyramide: Major Chloroquine and disopyramide are both associated with an increased risk of QT prolongation and torsades de pointes TdP.

Dofetilide: Major Coadministration of dofetilide and chloroquine is not recommended as concurrent use may increase the risk of QT prolongation. Dolasetron: Major Coadminister chloroquine with other drugs known to prolong the QT interval, such as dolasetron, with caution.