INFO - ACR: Plaquenil (hydroxychloroquine)

[Guest guest]

American College of Rheumatology

Updated April 2004

Plaquenil (hydroxychloroquine)

Description

Hydroxychloroquine (Plaquenil) is considered a disease modifying

anti-rheumatic drug (DMARD) because it not only can decrease the pain and

swelling of arthritis but may also prevent joint damage and reduce the risk

of long-term disability.

Uses

Hydroxychloroquine is in a class of medications called anti-malarials

that were first used to prevent and treat malaria. Today is used to treat

rheumatoid arthritis, some symptoms of systemic lupus erythematosus (lupus),

juvenile rheumatoid arthritis, and other autoimmune diseases.

How it works

It is not clear why hydroxychloroquine is effective at treating

autoimmune diseases. It is believed that hydroxychloroquine interferes with

communication of cells in the immune system.

Dosing

Hydroxychloroquine is generally given to adults as a 200 milligram

(mg) tablet twice a day or 400 mg once a day. In some cases, higher doses

can be used, or alternatively the dose may be reduced if patients do very

well.

Time to effect

Symptoms may start to improve in 1 to 2 months, but it may take up to

6 months before experiencing full benefits of this medication.

Side Effects

Hydroxychloroquine is usually very well tolerated and serious side

effects are rare. The most common side effects are nausea and diarrhea,

which often improve with time or by taking the medication with food. Less

common side effects include skin rashes or hair changes (bleaching or

thinning of hair), and neurologic side effects such as weakness. In rare

cases, hydroxychloroquine has caused visual changes or loss of vision. Such

vision problems are more likely to occur in individuals taking high doses

for many years. The dose used today is lower than the one originally used to

treat arthritis or malaria. At the current recommended dose, development of

visual problems while taking this medication is extremely unusual.

Points to remember

Although vision problems and loss of sight while taking

hydroxychloroquine for the treatment of lupus or arthritis is very rare, you

should notify your doctor if you notice any changes in your vision. Your

doctor also may ask you to have regular eye exams while taking this

medication. Any visual changes that do occur usually improve after stopping

the medication.

If you are pregnant or are considering having a child, discuss this

with your doctor before taking this medication. Although it is unclear if

hydroxychloroquine is associated with increased risk of birth defects, any

medication taken during pregnancy should be discussed with a doctor. Use of

an effective form of birth control is suggested throughout the course of

this treatment and up to 6 months after it is stopped.

Drug interactions

Although there are few drug interactions with hydroxychloroquine, to

be safe be sure to tell your doctor about all of the medications you are

taking, including over the counter drugs and natural remedies.

For more information

The American College of Rheumatology has compiled this list to give

you a starting point for your own additional research. The ACR does not

endorse or maintain these Web sites, and is not responsible for any

information or claims provided on them. It is always best to talk with your

rheumatologist for more information and before making any decisions about

your care.

National Institutes of Health Medline Plus link

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601240.html

ACR Position Statement on screening for hydroxychloroquine retinopathy

http://www.rheumatology.org/publications/position/hydroxy.asp?aud=prs

Lupus Foundation of America statement on hydroxychloroquine

retinopathy

http://www.lupus.org/education/topics/plaquenil.html

Updated April 2004.

Written by Cannon, MD, and reviewed by the American College of

Rheumatology Communications and Marketing Committee.

© 2005 American College of Rheumatology

http://www.rheumatology.org/public/factsheets/hydroxychloroquine.asp

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org