Hydroxychloroquine

Plaquenil 

Plaquenil is an essential medication used to treat autoimmune conditions like rheumatoid arthritis (RA) & systemic lupus erythematosus and to prevent and treat malaria. Available primarily in 200 mg tablets, Plaquenil helps reduce inflammation and manage symptoms by interfering with immune system processes. It is taken orally, preferably with food or milk, to minimize gastrointestinal discomfort. The dosage varies by condition, with specific regimens for malaria prevention and for managing chronic autoimmune diseases. Plaquenil requires vigilant monitoring due to potentially severe side effects, including retinal damage and effects on heart and liver health. Regular medical check-ups, including eye exams and blood tests, are crucial to safely managing treatment. Plaquenil is stored at room temperature, away from moisture and light, ensuring its efficacy is maintained. It is a potent medication that offers significant benefits when used correctly under careful medical supervision.

Product Overview

Plaquenil is a versatile medication widely used for the treatment and management of autoimmune diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and discoid lupus erythematosus (DLE), as well as for the prevention and treatment of malaria. Available primarily in 200 mg oral tablets, Plaquenil is designed to modulate the immune system by inhibiting the processing of antigens, which helps reduce inflammation and prevent tissue damage in autoimmune conditions. For malaria, it impedes the parasite’s ability to break down hemoglobin, effectively controlling and preventing infection.

Administered with food or milk to enhance absorption and reduce gastrointestinal discomfort, Plaquenil’s dosing varies based on the treated condition. For malaria prevention, the recommended dosage is 400 mg weekly, starting two weeks before exposure and continuing for four weeks after leaving the malaria-prone area. For RA and lupus, dosages may range from 200 mg to 600 mg daily, tailored to patient response and symptom control.

Plaquenil requires careful monitoring due to potential serious side effects. These include retinal damage, which necessitates regular eye exams, and possible severe heart and liver complications. Other notable risks include lowered blood cell counts and interactions with various drugs and supplements, affecting the medication’s efficacy and safety.

Patients are requested to follow their healthcare provider’s instructions precisely and attend all scheduled appointments to monitor for side effects. Plaquenil should be stored at room temperature and kept away from moisture and direct light to maintain its efficacy.

While effective, Plaquenil may not be suitable for everyone, especially those with pre-existing health conditions like liver disease or retinal disorders. Patients should discuss their full medical history and current medications with their healthcare expert to ensure Plaquenil is a safe option for their treatment plan.

What Are the Uses of Plaquenil?

• Uncomplicated malaria in adults and children
• Rheumatoid arthritis (RA) in adults
• Systemic lupus erythematosus (SLE) in adults
• Discoid lupus erythematosus (DLE) in adults

What Are the Forms & Strengths of Plaquenil?

Plaquenil is primarily prescribed in tablet form for 200 mg strength. 

What Are the Recommended Dosage of Plaquenil?

Plaquenil should be taken orally with food or milk.

Malaria Prevention:

• Adults: Start taking 400 mg orally once a week, beginning 2 weeks before traveling to a malaria-prone area. Continue taking the medication during your stay and for 4 weeks after leaving the area.
• Children (weighing 68 lbs or more): The typical dose is 6.5 mg/kg (up to 400 mg) by mouth once a week, as determined by the child’s provider.
• Children less than 68 lbs: Not recommended for use.

Malaria Treatment:

• Adults: Take an initial dose of 800 mg by mouth. Follow with 400 mg doses at 6 hours, 24 hours & 48 hours after the first dose.
• Children (weighing 68 lbs or more): The typical dose is 13 mg/kg (up to 800 mg) for the initial dose. Follow with 6.5 mg/kg (up to 400 mg) at 6 hours, 24 hours & 48 hours after the first dose, as determined by the child’s provider.
• Children less than 68 lbs: Not recommended for use.

Rheumatoid Arthritis:

• Starting Dose: 400 mg to 600 mg by mouth daily, taken in 1 or 2 doses.
• Maintenance Dose: Once symptoms are controlled, 200 to 400 mg daily, taken as a single dosage or in 2 smaller doses.

Lupus (SLE or DLE):

• The dosage is 200 to 400 mg by mouth daily, taken as a single dose or in 2 smaller doses.

[Note: Remember, these recommendations may vary from person to person. Discuss it with your medical specialist, and they’ll customize your dosage accordingly.]

How to Use Plaquenil? 

To use Plaquenil safely and effectively, follow these guidelines:

• Follow Your Prescription:

• • Take Plaquenil as prescribed by your healthcare expert.
  • Do not take more or less than the recommended dose.
• Dosage and Timing:
  • Plaquenil is usually taken once or twice daily, depending on your condition and doctor’s instructions.
  • Take the medication simultaneously each day to maintain consistent blood levels.
• With Food:
  • Take Plaquenil along with food or a glass of milk to decrease the risk of stomach upset.
• Swallow Whole:
  • Swallow the tablet whole; do not crush, chew, or break it.
• Regular Monitoring:
  • Attend all scheduled appointments with your healthcare expert.
  • Regular eye exams are necessary to monitor for potential retinal damage.
  • Blood tests may be required to check for side effects affecting blood cells and liver function.
• Avoid Alcohol:
  • Limit alcohol consumption while taking Plaquenil, as it can increase the risk of liver damage.

[Note: Your doctor will decide the suitable amount for you based on your condition, following guidelines & studies on the drug. They’ll adjust it as needed over time.]

How Does Plaquenil Work?

Plaquenil (hydroxychloroquine) is a medication used primarily to treat autoimmune diseases like rheumatoid arthritis & systemic lupus erythematosus and to prevent and treat malaria. It functions by interfering with communication between the cells of the immune system. Hydroxychloroquine is thought to inhibit the processing of antigens in the immune system, which reduces the inflammatory response. This modulation helps relieve the painful symptoms of inflammation and can prevent tissue damage. In the context of malaria, hydroxychloroquine acts by inhibiting the parasites’ ability to break down and metabolize hemoglobin, effectively starving the parasites and inhibiting their growth and reproduction. Despite its wide usage, hydroxychloroquine’s exact mechanisms of action in autoimmune treatment and malaria prevention are not entirely understood, and ongoing research continues to explore how this drug interacts at the cellular level.

Important Safety Information for Using Plaquenil

What Are the Side Effects of Plaquenil?

Common Side Effects of Plaquenil

• Digestive issues like diarrhea, nausea, vomiting, and abdominal pain
• Fatigue (low energy)
• Headache
• Dizziness
• Nervousness or irritability
• Ringing in the ears
• Weight loss
• Rash
• Hair loss*

Serious Side Effects of Plaquenil

• Muscle weakness
• Twitching
• Uncontrolled movements
• Loss of balance or coordination
• Blurred vision
• Sensitivity to light
• Seeing halos around lights
• Pale skin
• Easy bruising or bleeding
• Confusion
• Unusual thoughts or behavior
• Seizures (convulsions)
• Sudden vision loss, blurred vision, tunnel vision, eye pain, or swelling.
• Fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.
• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, coordination loss, unsteady, very stiff muscles, high fever, profuse sweating, or tremors.

[Note: Remember, this list does not cover all possible side effects of Plaquenil. Always consult with your healthcare specialist for medical advice about medication side effects.]

Are There Any Warnings for Plaquenil? 

Plaquenil can lead to serious health complications, particularly for individuals with certain risk factors. If you have concerns, discuss alternative treatments with your healthcare provider.

• Heart Rhythm Problems: Hydroxychloroquine can cause life-threatening heart rhythm issues, including QT prolongation, especially if you have electrolyte imbalances or are taking medications like amiodarone (Pacerone) or quetiapine (Seroquel). Seek quick medical help if you experience chest pounding, shortness of breath, chest pain, or fainting.
• Phospholipid Accumulation: Hydroxychloroquine may impair phospholipid processing, potentially causing drug-induced phospholipidosis and damaging organs. Symptoms to watch for include:
  • Cardiomyopathy: Difficulty breathing, chest pain, fatigue, and leg swelling.
  • Muscle Weakness: Nerve pain and reduced tendon reflexes.
  • Kidney Dysfunction: Difficulty urinating, weakness, poor appetite.
• Eye Damage: Long-term use can damage the retina, possibly leading to vision changes or loss. Regular eye exams are advised, and any vision changes should be immediately reported to your healthcare provider.
• Severe Skin and Allergic Reactions: Reactions can be life-threatening, including facial swelling and anaphylaxis, or severe skin reactions such as Stevens-Johnson syndrome. Discontinue use and seek urgent medical care if you develop a rash, fever, or skin peeling.
• Lowered Blood Cell Counts: Hydroxychloroquine can reduce red blood cells, white blood cells & platelets, increasing the risk of anemia, infections, and bleeding. Regular blood tests may be needed, and any signs of disease or unusual bleeding should be promptly addressed.
• Hemolytic Anemia: Particularly in individuals with certain genetic conditions, hydroxychloroquine can cause red blood cells to break down, leading to tiredness, dizziness, and weakness.
• Mental Health Effects: Reports of suicidal thoughts and behaviors have been noted. Immediate medical attention is necessary if you or someone around you notice changes in behavior or thoughts of self-harm.
• Low Blood Sugar: This medication can dangerously lower blood sugar levels. Diabetics should monitor their blood sugar closely. Symptoms of low blood sugar should be treated with fast-acting glucose. Persistently low levels after treatment require immediate medical attention.
• Exacerbation of Existing Conditions: Hydroxychloroquine may worsen psoriasis and porphyria. Careful consideration is required before prescribing to individuals with these conditions.

What Are the FDA Boxed Warning for Plaquenil?

Plaquenil has specific FDA-boxed warnings, the strongest warnings required by the FDA, indicating significant risks of severe or life-threatening adverse effects. The key boxed warnings for Plaquenil include the following:

• Retinal Damage: Prolonged use of Plaquenil can lead to irreversible damage to the eye’s retina, which can progress to permanent vision impairment. The risk of this medication is higher with higher doses or long-term use. Patients should undergo baseline and periodic eye examinations to monitor for visual changes, including visual acuity and retinal testing.
• Cardiac Effects: Hydroxychloroquine can cause cardiomyopathy, a condition that can lead to cardiac failure and an increased risk of mortality. Since cardiomyopathy may not be detected early, it is essential to monitor for clinical symptoms of cardiac compromise. Discontinue Plaquenil if cardiomyopathy develops.
• Exacerbation of Psoriasis: Plaquenil can worsen psoriasis. Patients with psoriasis should only use Plaquenil if the benefits outweigh the risks. If psoriasis exacerbation occurs, Plaquenil should be discontinued.

What Are the Plaquenil Precautions?

Before taking Plaquenil, it’s essential to discuss your medical history with your doctor to ensure it’s safe for you. Factors to consider before taking Plaquenil include:

• Eye problems: Although rare, Plaquenil can cause serious eye issues if you have conditions like macular degeneration. Discuss with your doctor whether it’s safe for you to take Plaquenil.
• G6PD deficiency: This condition affects red blood cell function, and taking Plaquenil could cause your red blood cells to burst. Inform your medical expert if you have G6PD deficiency to determine if Plaquenil is safe.
• Heart problems: Plaquenil can cause heart issues, such as irregular heart rhythm or cardiomyopathy. If you have pre-existing heart conditions, your doctor will assess if Plaquenil is appropriate for you.
• Kidney problems: Kidney issues may necessitate a lower dose of Plaquenil and can increase the risk of retinal toxicity. Discuss your kidney health with your doctor to ensure safe use.
• Liver problems: People with liver conditions might require a lower dosage of Plaquenil. If you have any liver problems, inform your doctor.
• Low blood cell counts: Plaquenil can affect blood cell levels. Your medical expert may check your blood cell counts before starting treatment to determine if Plaquenil is right for you.
• Low electrolyte levels: Low magnesium or potassium levels can increase the risk of heart problems with Plaquenil. Your doctor might treat these deficiencies before starting you on Plaquenil.
• Mental health conditions: Plaquenil can rarely cause mood changes, depression, or suicidal thoughts. If you have a history of mental health issues, discuss with your doctor whether Plaquenil is suitable for you.
• Porphyria or psoriasis: Plaquenil can worsen these conditions. Talk to your healthcare expert or pharmacist about the risks and benefits.
• Allergic reactions: If you’ve had an allergic reaction to Plaquenil or its ingredients, your doctor will likely suggest alternative medications.
• Plaquenil and Alcohol: There are no known safety issues with moderate alcohol consumption while taking Plaquenil. However, both Plaquenil and alcohol can cause liver damage, so combining them may increase this risk. Discuss your alcohol consumption with your medical professional to determine a safe amount.
• Pregnancy and Breastfeeding: The safety of Plaquenil during pregnancy and breastfeeding is not well-established. If you are pregnant, planning to conceive, or are a breastfeeding mother, consult your doctor to determine if Plaquenil is safe for you.

What Are the Contraindications of Plaquenil?

Plaquenil has specific contraindications where its use should be avoided or considered very carefully. Here are the primary contraindications for Plaquenil:

• Pre-existing Retinopathy: Plaquenil can exacerbate retinal diseases, particularly maculopathy and retinopathy. Patients with pre-existing retinal diseases should not use Plaquenil due to the risk of worsening eye conditions.
• Hypersensitivity: Patients with known hypersensitivity to hydroxychloroquine or other 4-aminoquinoline compounds should avoid using Plaquenil.
• Children Under Certain Conditions: Due to the risk of chronic toxicity, the use of Plaquenil in children for extended periods should be carefully considered, especially for conditions not related to malaria.
• G6PD Deficiency: Patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency may experience hemolytic anemia from Plaquenil and should avoid the drug.
• Cardiac Conditions: Use caution in patients with cardiac disease, particularly those at risk for cardiac conduction abnormalities, as Plaquenil can exacerbate these conditions.
• Liver or Kidney Dysfunction: Plaquenil should be taken with caution in patients with hepatic disease or alcoholism, in conjunction with known hepatotoxic drugs, and in those with severe renal impairment.
• Pregnancy and Breastfeeding: While Plaquenil has been used safely in pregnant women with autoimmune diseases, it should only be used when needed and after a thorough assessment of the risks & benefits by a healthcare expert.

What If You Missed a Dose of Plaquenil?

If you miss a dose of Plaquenil, here’s what you should do:

• Take the Missed Dose As Soon As You Remember: If it’s nearing the time for your next dose, skip the missed dose. Do not take two doses simultaneously to make up for the missed dose.
• Return to Your Regular Schedule: Continue taking your medication at the usual time. A consistent schedule is essential for maintaining stable drug levels in your body.
• Do Not Double Up: Never double the dose to catch up. This can increase the risk of side effects.
• Set Reminders: To help ensure you don’t forget future doses, consider setting alarms or reminders on your phone or using a daily pill box.
• Consult Your Healthcare Expert: If you frequently miss doses or are unsure how to handle a missed dose, talk to your healthcare provider for more specific guidance tailored to your treatment plan.

[Note: If you have missed a dose of Plaquenil and are unsure regarding the next one, immediately consult your medical expert or pharmacist.]

What Happens If You Take Too Much of Plaquenil?

Do not exceed the prescribed dosage of Plaquenil. Taking more than recommended can result in severe side effects and, in some rare cases, can be life-threatening.

Symptoms of overdose may include:

• Irregular heart rhythm
• Low blood pressure
• Low potassium levels in the blood
• Seizures
• Vision problems, such as temporary blindness
• Central nervous system depression
• Coma

[Note: If you have taken Plaquenil more than recommended, then get medical help immediately or call the Poison Help line at 1-800-222-1222.]

How to Store a Plaquenil?

• Store at room temperature, ideally between 68°F to 77°F.
• Store the medication in a dry place away from direct heat and moisture. Avoid storing it in the bathroom.
• Keep Plaquenil tightly closed in its original container to protect it from light.
• Ensure that Plaquenil is kept out of reach of children & pets to prevent accidental ingestion.
• Regularly check the expiration date on the Plaquenil packaging, and do not use the medication past this date.

[Note: Discuss with a certified medical expert the proper disposal of unused medicines and any questions you may have related to its storage.]

What Medications Interact with Plaquenil?

Plaquenil can interact with several types of medications, potentially altering their effects or increasing the risk of adverse reactions. Here are some fundamental drug interactions to be aware of:

• Antacids and Kaolin: Antacids or kaolin can reduce the absorption of Plaquenil, diminishing its effectiveness. It is recommended that Plaquenil be taken at least 4 hours before or after these medications.
• Ampicillin: Concurrent use with Plaquenil may reduce the absorption of ampicillin, potentially decreasing the effectiveness of the antibiotic.
• Cimetidine: Cimetidine can inhibit the metabolism of Plaquenil, elevating its levels in the blood & potentially leading to increased toxicity.
• Digoxin: Plaquenil can increase digoxin plasma levels, which may necessitate a dosage adjustment to prevent toxicity.
• Insulin and Oral Diabetes Medications: Plaquenil may enhance the effects of insulin & other diabetes medications, increasing the risk of hypoglycemia. When these medications are used together, closely monitoring blood sugar levels is advised.
• Antiepileptic Drugs: Some antiepileptic drugs, like phenobarbital and carbamazepine, may reduce Plaquenil’s efficacy by increasing its metabolism and clearance from the body.
• Methotrexate: The use of Plaquenil with methotrexate, commonly prescribed together for rheumatoid arthritis, can lead to increased levels of methotrexate, potentially heightening its efficacy and risk of toxicity.
• Tamoxifen: Co-administration with tamoxifen has been reported to increase the risk of retinal toxicity associated with Plaquenil.
• Certain Heart Medications: Plaquenil can affect the heart rhythm and may interact with other drugs known to cause heart arrhythmias, such as amiodarone or moxifloxacin, enhancing the risk for QT prolongation.
• Other Immunosuppressants: When taken with other agents that suppress the immune system, such as cyclosporine or tacrolimus, the risk of adverse effects may increase.

What Are the Other Plaquenil Interactions?

Plaquenil can interact with various supplements, herbs, foods, and beverages, which may affect how the medication functions or increase the risk of side effects. Here are some notable interactions:

• Supplements:
  • Calcium and Vitamin D: If taken simultaneously, these supplements might interfere with Plaquenil’s absorption. Space the ingestion of these supplements and Plaquenil for several hours.
  • Iron Supplements: Like calcium, iron can reduce the absorption of Plaquenil. It is best to take iron supplements from Plaquenil at a different time of day.
• Herbs:
  • St. John’s Wort: This herb may decrease the effectiveness of Plaquenil by increasing its metabolism in the liver.
  • Ginkgo Biloba: There is some concern that ginkgo could potentially increase the risk of bleeding when taken with drugs like Plaquenil, which can also affect clotting.
• Foods:
  • Grapefruit and Grapefruit Juice: Grapefruit can increase hydroxychloroquine levels in the blood, potentially leading to increased side effects.
  • High-Fiber Foods: Foods high in fiber may bind to Plaquenil and decrease its absorption if consumed simultaneously. It’s advisable to take Plaquenil at least a couple of hours before or after consuming a high-fiber meal.
• Beverages:
  • Alcohol: While there are no direct interactions between Plaquenil and alcohol, both can cause liver damage over time. If you are on Plaquenil, it may be wise to limit alcohol consumption to reduce stress on your liver.

[Note: This is not a complete list of medications and there could be other drugs that interact with Plaquenil. Ensure that you tell your doctor about any prescription, over-the-counter medicines & herbal products you’re taking.]

What Are the Plaquenil Alternatives?

• Rheumatrex, Trexall (methotrexate)
• Imuran (azathioprine)
• Azulfidine (Sulfasalazine)
• Arava (Leflunomide)
• CellCept (Mycophenolate Mofetil)
• Aralen (Chloroquine)
• Lariam (Mefloquine)
• Malarone (Atovaquone/Proguanil)
• Vibramycin, Oracea (Doxycycline)
• Primaquine (generic name same as brand)
• Neoral, Sandimmune (Cyclosporine)
• Actemra (Tocilizumab)
• Rituxan (Rituximab)
• Orencia (Abatacept)

[Note: Your medical expert will choose the most suitable medication alternative for you. Don’t use any of the above-mentioned Plaquenil alternatives without medical supervision. Taking them on your own may cause serious side effects.]

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Frequently Asked Questions

How long does it take for Plaquenil to start working?

If you’re using Plaquenil for rheumatoid arthritis (RA), you may notice improvements in your symptoms within a couple of weeks to months of starting treatment. Significant benefits may take up to 6 months of regular use for some individuals. Response times vary, so it’s important to discuss your concerns about the effectiveness and timeline of Plaquenil with your healthcare provider.

Is Plaquenil considered an immunosuppressant?

Plaquenil is classified as a non-biologic DMARD (disease-modifying antirheumatic drug). While it doesn’t directly suppress immune cells like white blood cells, it alters immune system processes, reducing overall immune activity. This can occasionally lead to lower blood cell counts and related side effects, such as increased infection risk, though this is rare and more likely with long-term use. Discuss any concerns about Plaquenil and its impact on your immune system with your healthcare provider.

Can Plaquenil cause weight gain?

Plaquenil is not commonly associated with weight gain as a side effect. In fact, some users have reported weight loss while taking the medication, though it’s not clear how many people are affected or if Plaquenil directly causes the weight loss. If you experience unusual weight changes during treatment, discussing this with your healthcare provider is important.

Can Plaquenil cause hair loss?

Some individuals taking Plaquenil have reported hair loss or alopecia, although it is unclear how widespread this side effect is or if the medication directly causes it. If you experience hair loss while using Plaquenil, it is advisable to consult your healthcare expert to explore potential causes and appropriate responses.

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