Plaquenil

Brand Names: Plaquenil

Common Name: hydroxychloroquine

What is this drug used for?

Hydroxychloroquine belongs to a group of medications known as anti-inflammatories and antimalarials. It is used alone or in combination with other anti-arthritic medications to treat rheumatoid arthritis because it helps to reduce pain, stiffness, and swelling in joints. It may take several weeks before the beneficial effects of hydroxychloroquine for the treatment of rheumatoid arthritis are seen.

Hydroxychloroquine is also used to treat and prevent certain types of malaria. It is also used for the treatment of systemic lupus erythematosus (SLE).

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

Is there any reason not to take this drug?

Hydroxychloroquine should not be taken by anyone who is:

• allergic to hydroxychloroquine, any of the 4-aminoquinoline compounds, or to any of the ingredients of the medication
• previously diagnosed with retinopathy of the eye
• under 6 years of age

What about possible side effects?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• bleaching of hair or increased hair loss
• blue-black discoloration of fingernails or inside of mouth
• diarrhea
• difficulty in seeing to read
• dizziness or lightheadedness
• headache
• itching
• loss of appetite
• nausea
• nervousness or restlessness
• skin rash
• stomach cramps or pain

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• blurred vision or any change in vision - this effect may also occur or worsen after stopping the medication
• increased muscle weakness
• mood or other mental changes
• ringing or buzzing in ears or any loss of hearing
• unusual tiredness or weakness
• vomitting

Stop taking the medication and seek immediate medical attention if any of the following occur:

• convulsions (seizures)
• difficulty breathing
• sore throat and fever
• unusual bleeding and bruising

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

What if I am taking other drugs?

There may be an interaction between hydroxychloroquine and any of the following:

• diabetes medications (e.g., glyburide, chlorpropamide, rosiglitazone)
• digoxin
• insulin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Other information:

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Blood tests: If you take this medication for a long period of time, your doctor will likely want you to have blood tests to make sure that your levels of red and white blood cells have not been affected.

Drowsiness/blurred vision: While taking this medication, use caution when driving or operating machinery, since hydroxychloroquine can cause blurring of vision. If your vision blurs, call your doctor.

Eye damage: Irreversible damage to the retina of the eye has occurred for some people who take long-term or high-dosage treatment with hydroxychloroquine. Eye damage is more likely to occur if recommended doses are exceeded. Your doctor will want you to have regular eye exams if you take this medication for a period of time. If you notice any new problems with sight or symptoms, such as light flashes and streaks, stop the medication at once and call your doctor.

Kidney disease: People with kidney disease may need a lower dose of this medication. If you have kidney disease, you should talk to your doctor about how this medication may affect your medical condition, how the medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver disease: People with liver disease may need a lower dose of this medication. If you have liver disease, you should talk to your doctor about how this medication may affect your medical condition, how the medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Muscle weakness: Call your doctor if you notice any unusual evidence of muscular weakness.

Other medical conditions: If you have stomach, nerve, blood, or skin disorders, speak to your doctor about the risks and benefits of using this medication.

Pregnancy: Hydroxychloroquine should be avoided during pregnancy except for the suppression or treatment of malaria when, in the judgment of your doctor, the potential benefits may outweigh the potential risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes in small amounts into breast milk. Infants are extremely sensitive to its side effects. If you are a breast-feeding mother and are taking hydroxychloroquine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and efficacy of this medication has not been established for children when taking hydroxychloroquine for treatment of rheumatoid arthritis or systemic lupus erythematosus. Children are especially sensitive to the side effects of hydroxychloroquine.

Special Instructions:

The recommended doses of the medication vary according to the condition being treated. Hydroxychloroquine should be taken with a meal or a glass of milk.

Rheumatoid arthritis: The usual adult starting dose is 400 mg to 600 mg daily. It may take several weeks before the beneficial effects of hydroxychloroquine for the treatment of rheumatoid arthritis are seen, and several months before maximum effects are achieved.

Lupus: The usual starting dose for adults is 400 mg once or twice daily. This dose may be continued for several weeks or months depending on the benefits that occur. The long-term dose of hydroxychloroquine is usually reduced to 200 mg to 400 mg daily.

Malaria: The recommended preventative adult dose is 400 mg on exactly the same day of each week, beginning 2 weeks before exposure. Children's doses are based on body weight. For treatment of acute attacks of malaria, the recommended starting dose for adults is 800 mg followed by 400 mg after 6 to 8 hours. This is followed by 400 mg on each of the next 2 days for a total of 2,000 mg of hydroxychloroquine. Some doctors may decide to prescribe a single dose of 800 mg only, as this method has also been found effective in the treatment of malaria. Children's doses are based on body weight as prescribed by the doctor.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep this medication out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

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