Chloroquine phosphate

Humblefish

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Chloroquine phosphate: Treats Ich (Cryptocaryon irritans), Marine Velvet Disease (Amyloodinium), Brooklynella hostilis & Uronema marinum.

How To Treat - Chloroquine phosphate (CP) is a “new drug” that actually was widely used to control external protozoa in saltwater aquariums back in the 70s & 80s. It was even used in some aquarium medications sold at LFS. Nowadays CP requires a prescription to purchase legitimately, making it more difficult to obtain. Fast forward to today and thanks to the power of the Internet, CP has come roaring back! The biggest obstacle to overcome is obtaining pharmaceutical grade 99% pure CP. I cannot stress the importance of this enough. Do not buy it from some guy on eBay or even an online vendor. The only way to be sure you are getting 99% pure CP is to get your vet (or an MD) to write a prescription which can then be filled by a compounding pharmacy.

CP is a “one and done” medication, meaning you dose once and that’s it. There are no test kits for CP, so it’s important that you dose accurately using a digital scale. Also, don’t forget to dose any replacement water (from water changes, but not top-off) with CP. The dosage rates are as follows:
  • Prophylactic treatment is 40 mg per gallon.
  • For active infections (visible symptoms present), I typically will up the dosage to 60mg/gal. However, I cannot say if this is anymore effective than the "standard" 40mg/gal dose.
  • For Uronema marinum and really bad infestations, you can dose up to 80mg/gal. However, I have noticed appetite suppression and lethargy at this concentration. :oops:
As you can see, there is quite a bit of wiggle room between the minimum & maximum dosage. Practically speaking, 40mg/gal will treat all external protozoa issues… its just that the higher dosages may get the job done a little faster. Treatment lasts 30 consecutive days, and no carbon, UV, etc. may be used during this time (although it can be used later when you wish to remove the medication from the water.) A little quirk about CP is that light will degrade it; however it appears this mainly applies to the powder itself, so store your CP in a cool, dark place. Once in water, you may use an aquarium light with CP - however fish with velvet are light sensitive so I would only use ambient lighting (ex. lamp across the room) if treating for that. CP is NOT reef safe. In addition to killing your corals, it is a very strong algaecide.

Pros - Gentle on most fish (see DO NOT USE list below), a “one and done” medication that treats most external protozoa. CP is the closest thing there is to a “wonder drug” in our hobby.

Cons/Side Effects - Expensive, hard to get (requires a prescription), powder is heat & light sensitive - so store in a cool, dark place. Attempts to feed CP laced food are usually not successful due to its bad metallic taste.

** Based upon anecdotal experience (mine and others), DO NOT USE CP on Anthias, Wrasses or Hippo Tangs. For the time being, chelated copper (exs. Coppersafe, Copper Power) is the best alternative to use on these species. **

** Finally, a place to buy Chloroquine: https://www.reef2reef.com/threads/a-place-to-buy-chloroquine.252610/ **

** Special thanks to @svogun for providing this link, which can be used to find aquatic vets in your area for sourcing CP: http://www.aquavetmed.info/ **
 
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Reposted with permission.
Below is alprazo's "Chloroquine Primer". I consider alprazo to be the "founding father" of CP; because without his insistence, the usefulness of this medication would have been lost to ignorance.

Treats:Amyloodinium (velvet)
Cryptocaryon (Ich)
Uronema marinum - with recurrence upon cessation and return to display
Possibly Brooklynella

Compatible with:
Praziquantil - YES (the known interaction has to do with cytochrome P450 in the first pass, hepatic metabolism of praziquantil and is not relevant when treating in bath formulation)
Amquel - YES
Prime - YES
Nitrofurazone (furan II) - YES
UV light - NO
Dimilin - YES
Copper - MAYBE (evidence exists that it my be synergistic)

Dosing:
10mg/l or 40mg/gal bath formulation
50 mg/kg - oral

Duration:
30 days - single dose - Ich
14 days - single dose - velvet

Degradation:
Carbon - removal
Light in the UV near visible light spectrum (390 nm) CF lighting with typical peaks in the 500s and 600s should be fine.

Half life:
After one oral dose at 50mg/kg - mucus levels remained therapeutic for 7 days and detectable for 30 days for velvet.

Activity:
In velvet, 10mg/l dose resulted in 100% dinospore inactivity at 48 hrs and 100% cure at 14 days. At a dose of 25 mg/l it took 24 hrs for 100% inactivity.

Lethal dose:
A dose of 200mg/l showed no adverse organ effects on necropsy.

Contraindications:
Pipefish
Sea dragons
possibly some wrasse

Miscellaneous:
Chloroquine has a known anti-inflammatory effect. In theory this could possibly reduce gill edema and increase oxygen transport (The gill edema and poor oxygen transport is what kills our fish)

It has been used in aquaculture since the late 70s

There is no known antibacterial activity and therefore will not effect biologic filtration

Strong algicidal activity
 
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revhtree

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Great info!
 
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Humblefish

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Below are my anecdotal observations with CP:
  • It is effective against external protozoans (ich, velvet, brook, uronema) when used in a bare bottom, rockless QT.
  • CP works the same as copper, successfully targeting the “free swimming” or theront stage. Treatment lasts 30 consecutive days (same as copper). Its advantage over copper is greatly reduced side effects.
  • No practical "test kit" for CP exists. It is a “one and done” medication, meaning you dose once and that’s it. It’s important that you dose accurately using a digital scale. Typically, I do a 100% water change in-between batches of fish and then re-dose. A metabolite of chloroquine – hydroxycloroquine – has a long half-life of 32–56 days, so it's not a good idea to use a single dosage past one month anyway.
  • Using CP in a display tank or any tank with rock/substrate almost always fails to eradicate the parasites. I believe this to be due to absorption. Just like with copper, rocks/substrate absorb CP, dropping it below therapeutic levels. And since there is no test kit, there is no way of knowing how much CP to add back to raise the level.
  • Using pharmaceutical grade 99% pure CP (the 1% is a binder) in a bare bottom, rockless QT environment for 30 days has worked for me every single time. For over 5 years now. However, I have read numerous anecdotal accounts where CP bought off eBay or some online vendor fails. I believe this is because these sources will often "water down" their CP using fillers to increase profitability. Or if CP is originally sourced from outside the country, say China for example; then their QC standards might not be the same as here. Which is why the only way to be sure you are getting the "good stuff" is to get your vet to write you a prescription that can then be filled at a local pharmacy.
  • CP probably does nothing for internal parasites/worms (i.e. flukes) and bacterial infections. CP is NOT reef safe. CP WILL NOT wipe out your QT's bio-filter.
  • DO NOT run a skimmer, carbon, UV, ozone, polyfilter, etc. with CP. Also, there is some debate over how much light is required to break CP down - so best to treat in ambient lighting.
  • CP is widely used by Marine Biologists and Public Aquariums. Why we, the hobbyists, have been left in the dark for so long about it is truly mind boggling.
 
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I've noticed that the powder form of CP is getting harder to find, and many pharmacies are wanting to substitute it with CP tablets. The tablets are fine to use, but the downside is you get less "chloroquine base" out of them so you must dose more (which becomes more expensive). The following was taken from Bob Goemans online book, THE LIVING AQUARIUM MANUAL:
In most cases, 250 mg tablets have an equivalence of 150 mg chloroquine base, and 500 mg tablets have an equivalence of 300 mg chloroquine base. Although the purity mentioned above is generally accurate, it would be best to verify the chloroquine base contained in the tablets of your choice in order to be able to properly calculate the exact dosage. Keep in mind if you decide to use the tablets, there are some inactive ingredients, which you may have to deal with, e.g., Camauba Wax, Colloidal Silicon Dioxide, Dibasic Calcium Phosphate, Hydroxypropyl Methylcellulose, Magnesium Stearate, Microcrystalline Cellulose, Polyethylene Glycol, Polysorbate 80, Pregelatinized Starch, Sodium Starch Glycolate, Stearic Acid, and Titanium Dioxide. And as mentioned earlier in this chapter there are occasions where some medicines are not in their pure form (100% pure), i.e., mixed with a substance called a 'carrier,' which should be noted on its label. If so its potency is reduced, and if not sure about the exact amount of medication needed, suggest contacting a more experienced aquarist for the way to resolve this situation.
 

kmaintl

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An employee at or local public aquarium told me 2 years ago that they use CP for disease management. I have been using ever since. I use 24/7 on my quarantine and hospital tanks. I once did a 5 month test on one of my FOWLR display tanks and had no ill effect on tangs, angelfishes, clownfishes, dottybacks and a coris wrasse. I asked our local public aquarium what their source for CP and they buy directly from Fishman's Chemical. Just don' follow FC's dosing advice as you can loose your fishes. One dose takes care of it until you do a water change.

I collect a lot of clownfishes and sometimes they come in it ich, velvet or brook. I use to use copper, but by the time I discover they have brook... it's too late and they end up dying. Copper has no effect on brook and it is a fast destructive disease. I had clownfishes come in with brook on several occasions and over 95% were saved and responded well to CP.

Now I treat all fishes in quarantine with CP for 3 months... whether there is any signs or disease or not. I am on my 3rd Kg of CP as many of the locals asked me for some.
 

Deinonych

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Great post. I would emphasize the point about dosing in the DT - just don't do it. Rock and sand affect the dosage somehow (possibly via adsorption), and since there are no test kits (unless you have access to a spectrophotometer), you have no way of knowing whether you are maintaining therapeutic dosage. I would also emphasize that it is best to keep all aquarium lighting off during treatment, as UV denatures the compound.
 

kmaintl

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Great post. I would emphasize the point about dosing in the DT - just don't do it. Rock and sand affect the dosage somehow (possibly via adsorption), and since there are no test kits (unless you have access to a spectrophotometer), you have no way of knowing whether you are maintaining therapeutic dosage. I would also emphasize that it is best to keep all aquarium lighting off during treatment, as UV denatures the compound.
Totally agree. If you have UV or MH, needs to be off. I QT with just the room ceiling flourscent lights and some low wattage LEDs (no UV). As for main display, I don't recommend as well. I was testing if any ill effect if fishes subject to long periods of CP treatment. Test went on for 5 months with no signs of ill effects. Every water change, I dosed back up double the required amount to compensate for any absorption. Best of remove the disease fish and use a stand alone hospital tank.
 

firemedix911

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So will I be able to go to the pharmacy with a prescription and get chloroquine powder if I request so thru a prescription or will I have to get the tablets?
 
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Humblefish

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So will I be able to go to the pharmacy with a prescription and get chloroquine powder if I request so thru a prescription or will I have to get the tablets?
Seems to vary by the pharmacy. Probably depends upon whatever their supplier has. Ask for the powder. If all they have are the tablets, try another pharmacy (or maybe locate a compounding pharmacy.) At the end of the day the tablets are perfectly fine to use. However, being they contain less usable "chloroquine base" means you have to dose more (which becomes more expensive). See below for more details:

In most cases, 250 mg tablets have an equivalence of 150 mg chloroquine base, and 500 mg tablets have an equivalence of 300 mg chloroquine base. Although the purity mentioned above is generally accurate, it would be best to verify the chloroquine base contained in the tablets of your choice in order to be able to properly calculate the exact dosage. Keep in mind if you decide to use the tablets, there are some inactive ingredients, which you may have to deal with, e.g., Camauba Wax, Colloidal Silicon Dioxide, Dibasic Calcium Phosphate, Hydroxypropyl Methylcellulose, Magnesium Stearate, Microcrystalline Cellulose, Polyethylene Glycol, Polysorbate 80, Pregelatinized Starch, Sodium Starch Glycolate, Stearic Acid, and Titanium Dioxide. And as mentioned earlier in this chapter there are occasions where some medicines are not in their pure form (100% pure), i.e., mixed with a substance called a 'carrier,' which should be noted on its label. If so its potency is reduced, and if not sure about the exact amount of medication needed, suggest contacting a more experienced aquarist for the way to resolve this situation.
 

Deinonych

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New Life Spectrum now offers a CP product called Ick Shield that is supposedly effective. I have not used it, but have seen reports on another forum that it works well.

http://www.amazon.com/dp/B00MNQWACU
 
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Humblefish

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This place has my attention as a source for CP and other meds: Fish Remedies, LLC - FULL PRODUCT LISTING

However, everything is sold by the kg so they obviously geared towards wholesalers and public aquariums.
 

merlberg

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So is there any other way to get CP for treating ich or do I have to get a prescription for it? And who do I go for this prescription... A VET or a regular MD Sry if Thts a silly question?
 
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Humblefish

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A vet will sometimes write you a prescription, which can then be filled at a local pharmacy. Sometimes the pharmacy has to special order it. Unfortunately, all this takes precious time your puffer may not have if the ich infestation is heavy. But it's worth looking into for future similar QT situations.
 

merlberg

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Yes you're right and that is what I'm worried about it taking time for me to actually get the med in my possesion ... It is worth looking into just to have. I feel right now the copper is my only option idk
 
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Humblefish

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Yes you're right and that is what I'm worried about it taking time for me to actually get the med in my possesion ... It is worth looking into just to have. I feel right now the copper is my only option idk
Your best options for immediate relief are tank transfer method, and hyposalinity being a distant second.
 

cmantis

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I have a lot of CP never tried to find it in smaller doses but someone on ebay sells it.
 

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