Hydroxychloroquine (Plaquenil)

medication bottles

Hydroxychloroquine (Plaquenil) is considered a disease-modifying anti-rheumatic drug (DMARD). It can decrease the pain and swelling of arthritis. It may prevent joint damage and reduce the risk of long-term disability. Hydroxychloroquine is in a class of medications that was first used to prevent and treat malaria. Today, it is used to treat rheumatoid arthritis, some symptoms of lupus, childhood arthritis (or juvenile idiopathic arthritis) and other autoimmune diseases. It is not clear why hydroxychloroquine is effective at treating autoimmune diseases. It is believed that hydroxychloroquine interferes with the communication of cells in the immune system.

How to Take It

Hydroxychloroquine comes in an oral tablet. Adult dosing ranges from 200 mg or 400 mg per day (6.5mg/kg). In some cases, higher doses can be used. It is recommended one tablet twice daily if taking more than one tablet. It is recommended to be taken with food. Symptoms can start to improve in one to two months, but it may take up to six months before the full benefits of this medication are experienced.

Side Effects

Hydroxychloroquine typically is very well tolerated. 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 rash changes in skin pigment (such as darkening or dark spots), hair changes, and muscle weakness. Rarely, hydroxychloroquine can lead to anemia in some individuals. This can happen in individuals with a condition known as G6PD deficiency or porphyria.

In rare cases, hydroxychloroquine can cause visual changes or loss of vision. Such vision problems are more likely to occur in individuals taking high doses for many years, in individuals 60 years or older, or in those with significant kidney disease. The dose used today to treat arthritis is lower than doses used in the past to treat malaria. At the recommended dose, development of visual problems due to the medication is rare. It is recommended that you have an eye exam every 6 - 12 months while on hydroxychloroquine therapy.

Tell Your Doctor

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.

Be sure to notify your other physicians when taking this drug. This drug does not have a strong effect on the immune system, so vaccines recommended by other physicians are generally acceptable. Notify your eye doctor when you are on this medication so regular visual screening tests can be performed. If you are pregnant, considering becoming pregnant, or lactating, please discuss this with your doctor before taking this medication.

Updated March 2017 by Jennifer Murphy, MD and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

© 2017 American College of Rheumatology