What is Hydroxychloroquine?

Why is Hydroxychloroquine prescribed?

What are the possible side-effects?

What are the risks?

What else should I know about Hydroxychloroquine?

What is Hydroxychloroquine?

Hydroxychloroquine (trade name Plaquenil) is a disease modifying anti-rheumatic drug (DMARD). These drugs have the effect of dampening down the underlying disease process, rather than simply treating symptoms.

What type of drug hydroxychloroquine (trade name Plaquenil)?

Hydroxychloroquine acts as a disease-modifying anti-rheumatic drug (DMARD).

What does it do?

It reduces the activity of the immune system, which can become overactive in diseases like rheumatoid arthritis and systemic lupus erythematosus (SLE).

What is it used for?

It is used to treat rheumatoid arthritis and also discoid lupus and systemic lupus erythematosus (SLE).

How is it taken?

It is usually given as 200–400mg tablets daily to begin with. The dose may be reduced after a few months, and when your condition is very well controlled you may only need to take hydroxychloroquine 2–3 times per week.

Are there any side-effects?

Side-effects are uncommon, but some people may experience skin rashes, indigestion, diarrhoea, headaches and blurred vision.

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Why is hydroxychloroquine prescribed?

Hydroxychloroquine is used to treat rheumatoid arthritis and also discoid and systemic lupus erythematosus (SLE). Over the long term it can reduce inflammation and so reduce pain, swelling and joint stiffness. It may also improve the rash in patients with lupus. It is often taken in combination with other drugs (such as methotrexate) to control rheumatoid arthritis or lupus.

Hydroxychloroquine is also used in the prevention and treatment of malaria. However, if you are travelling to an area where there is a risk of getting malaria you should not assume that hydroxychloroquine will protect you. The dosing is different and not all forms of malaria can be treated with hydroxychloroquine. You should always take medical advice about the best drug to use for malaria protection.

Is there any reason I will not be prescribed hydroxychloroquine?

Hydroxychloroquine will not usually be prescribed if you have existing maculopathy of the eye (problems with the central part of the retina).

When and how do I take hydroxychloroquine?

Hydroxychloroquine is taken in tablet form, with or after food. Your doctor will advise you about the correct dose. Usually you will start on a full dose of 200–400 mg daily, and later your doctor may reduce this. When your condition is very well controlled you may be advised to take hydroxychloroquine only 2–3 times per week.

How long does hydroxychloroquine take to work?

Hydroxychloroquine does not work immediately. It may be 12 weeks or longer before you notice any benefit.

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What are the possible side effects?

Side-effects are uncommon. However, in some people hydroxychloroquine can cause the following:

  • skin rashes, especially those made worse by sunlight
  • nausea or indigestion
  • diarrhoea
  • headaches
  • bleaching of the hair or mild hair loss
  • tinnitus (ringing in the ears)
  • blurred vision.

Very rarely (in about 1 in 2000 cases) hydroxychloroquine may damage the retina (part of the eye). This can cause problems with vision, in particular with colour vision. Monitoring of your eyes is sometimes arranged at a hospital clinic. If not, it is advisable to have an eye check with an optician once a year and to tell them that you are taking hydroxychloroquine.

If you develop any new symptoms or there is anything else that concerns you after starting hydroxychloroquine, you should tell your doctor or rheumatology nurse specialist as soon as possible.

You should always read the patient information leaflet included with your medicines package to keep you informed about any possible side effects of your prescribed medications.

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What are the risks?

Will it affect vaccinations?

You can have vaccinations while on hydroxychloroquine.

Can I drink alcohol while on hydroxychloroquine?

There is no particular reason to avoid alcohol while on hydroxychloroquine. However, you may need to consider any other drugs you are taking, such as methotrexate which can interact with alcohol.

Does hydroxychloroquine affect fertility or pregnancy?

If you are planning a family or if you become pregnant while taking hydroxychloroquine, you should discuss this with your doctor as soon as possible. Hydroxychloroquine is generally considered to be safe in pregnancy. It is usually best to continue taking it to prevent a flare of disease as the benefits of the medication outweigh the possible risks.

Does it affect breastfeeding?

You can breastfeed if you are on hydroxychloroquine. Although the drug may pass into the breast milk, this is not likely to have any effect on the baby. The benefits of continuing to take hydroxychloroquine to control your disease outweigh any risk.

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What else should I know about Hydroxychloroquine?

Are there any alternatives?

A number of other drugs are used in the treatment of rheumatoid arthritis, lupus (SLE) and related conditions. Your doctor or rheumatology nurse specialist will discuss these other options with you.

Will I need any special checks while on hydroxychloroquine?

Before starting on hydroxychloroquine your doctor may take a blood test to check that your liver and kidneys are working normally, but you will not need any regular blood tests during the treatment. Your doctor will ask you about any problems with your eyesight and may check your vision before you start the medication. Your doctor will explain to you how your vision will be monitored during treatment (often with a yearly review) and will ask you to report any visual symptoms. If you have other eye problems before starting hydroxychloroquine you may need more frequent checks.

Can I take other medicines alongside hydroxychloroquine?

Hydroxychloroquine is commonly given alongside other disease-modifying anti-rheumatic drugs (DMARDs), especially in rheumatoid arthritis, rather than being prescribed on its own. Depending on your symptoms, this may happen in lupus too.

Some drugs interact with hydroxychloroquine – for example, indigestion remedies (including some over-the-counter preparations) can stop hydroxychloroquine being absorbed. It is recommended that you wait at least 4 hours after taking hydroxychloroquine before you take an indigestion remedy (antacid). You should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are taking hydroxychloroquine. You should also be aware of the following points:

  • Hydroxychloroquine is not a painkiller. If you are already on a non-steroidal anti-inflammatory drug (NSAID) or painkillers you can carry on taking these as well as hydroxychloroquine, unless your doctor advises otherwise. If hydroxychloroquine works for you, you may be able to reduce your NSAIDs or painkillers after a time.
  • Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse specialist or pharmacist.

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