Chloroquine phosphate

Humblefish

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Chloroquine Phosphate *** The information contained here is subject to changes as I experiment and learn more about Chloroquine Phosphate ***

What It TreatsMarine Ich (Cryptocaryon irritans), Marine Velvet Disease (Amyloodinium ocellatum), Brooklynella hostilis and Uronema marinum.

How To Buy – Chloroquine phosphate (CP) is an antimalarial drug for humans which also treats external parasites that afflict marine fish (and possibly freshwater fish as well.) However, there are a few challenges to overcome with CP. The very first is obtaining it because a prescription is usually required to buy pharmaceutical-grade CP. While pharmaceutical-grade is not an absolute requirement, the closer the medication is to being 99% pure the more effective it is. Many CP failures can be traced back to buying the medication on eBay or from some other unknown source. The best strategy for obtaining CP is to ask your local veterinarian for a prescription which can then be filled by a compounding pharmacy: https://www.diamondbackdrugs.com/chloroquine/

A backup plan is to buy from this source, which has tested 94-96% pure for me (although I cannot guarantee every batch from this source will test the same): https://store.nationalfishpharm.com/items/view/616/chloroquine-phosphate

Sometimes CP is dispensed in tablet form instead of powder. The tablets are fine to use, but the downside is you get less “chloroquine base” out of them so you must dose more. 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.
How To Dose – In most cases CP is dispensed in powder form, and a digital scale is needed to accurately measure the dosage (more info on that below). This is the one I use:


How To Treat – Okay, so you’ve got your CP + digital scale and are ready to dose! Well, this brings us to the next challenge to overcome: Bacteria and biofilm. All medications (except copper) that you dose into water are susceptible to biodegradation. With Chloroquine this can be a major problem because the medication needs to be at a therapeutic level at all times in order to be effective. Therefore, I highly recommend following one of these QT protocols when using CP:

CP Protocol #1 (preferred): Dose 15 mg/L (60 mg/gal) into a bare bottom, rockless QT (see pic below) and treat for 10 days. The tank (and all equipment) should have been cleaned/sterilized beforehand and no biological filtration should be used! The point is to limit the bacteria/biofilm found in the aquarium which could degrade CP. Ammonia can be controlled by dosing Prime/Amquel every 24-48 hours, or by doing water changes. (A Seachem ammonia alert badge can be used for active monitoring.) However, when performing a water change it is very important to dose CP back into any replacement water before adding it to the QT. This ensures that the concentration of medication in the QT remains therapeutic at all times. After 10 days, transfer the fish into an observation tank (see Posttreatment below) at least 3 m (10 feet) away from the QT.


CP Protocol # 2: If you must treat in an established QT with a working biofilter, then you should redose the medication to compensate for possible biodegradation. Start off by dosing 10 mg/L (40 mg/gal) and then subsequently dose 1 mg/L (4 mg/gal) every day thereafter. Daily redosing is ideal, but if that conflicts with your schedule then redosing 3 mg/L or 12 mg/gal every 3 days (for example) should still be adequate. CP has a wide therapeutic range (20-80 mg/gal), so the objective is to keep it within that concentration at all times. After 10 days, transfer the fish into an observation tank (see Posttreatment below) at least 3 m (10 feet) away from the QT.

Posttreatment – To ensure treatment has been successful, transfer the fish into a nonmedicated observation tank for 2-4 weeks. Never transfer the fish directly into your display tank! The point of the observation tank is to ensure treatment has been successful, and symptoms of parasites do not resurface. One way to accomplish this is by housing black mollies (more info) in your observation tank. A freshwater black molly will have no immunity whatsoever to marine diseases, thus making it probable for visible symptoms to show. And evidence of ectoparasites (e.g. ich, velvet, brook) will show up as white spots on a black molly or translucent if a tankmate has flukes.

Pros – Gentle on most fish. (DO NOT USE with Hippo Tangs, anthias and flasher wrasses.) CP treats most external protozoa, and is probably 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. CP is quickly removed from the water if carbon is used and even by certain filter pads which are made from polyfiber. The medication is also susceptible to biodegradation, which makes dosing in an established QT somewhat unpredictable.
 
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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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Great info!
 
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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.
 

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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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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.
 
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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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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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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.
 
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