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Hydroxychloroquine: Uses, Dosage, and Side Effects Explained
Summary of Key Points
Hydroxychloroquine is a medication commonly used to treat conditions such as rheumatoid arthritis, lupus, and malaria. It works by reducing inflammation and modulating the immune system. In some cases, it may also be prescribed for other conditions, including Sjögren’s syndrome and COVID-19. It is essential to take this medication exactly as directed by your healthcare provider. If you have any questions about your dosage or potential side effects, reach out to one of our telemedicine providers for guidance.
Names of Medication
US Brand Name: Plaquenil
Generic Name: Hydroxychloroquine
The generic name is the standard name for a medication, while the brand name is the name given by the manufacturer. The generic name is often listed in parentheses.
Pharmacologic Category
Hydroxychloroquine falls under the following pharmacologic categories:
- Antimalarial
- Antirheumatic
- Immunomodulator
Hydroxychloroquine Dosage
The dosage of hydroxychloroquine varies depending on the condition being treated. Always consult your doctor before making any changes to your dose. Our telemedicine providers are available to assist with any questions you may have.
Rheumatoid Arthritis
Initial Dose: 400-600 mg daily, divided into two doses.
Maintenance Dose: 200-400 mg daily.
Length of Treatment: Long-term use may be necessary to manage symptoms effectively.
Lupus Erythematosus (Systemic and Discoid)
Initial Dose: 400 mg once or twice daily.
Maintenance Dose: 200-400 mg daily.
Length of Treatment: Long-term use may be required.
Malaria (Prophylaxis and Treatment)
Prophylaxis Dose: 400 mg once weekly, starting 1-2 weeks before exposure and continuing for 4 weeks after leaving the area.
Treatment Dose: 800 mg initially, followed by 400 mg at 6, 24, and 48 hours after the first dose.
Length of Treatment: Short-term for treatment; long-term for prevention.
Sjögren’s Syndrome
Typical Dose: 200-400 mg daily.
Length of Treatment: Long-term use may be necessary to control symptoms.
Porphyria Cutanea Tarda
Typical Dose: 200 mg twice weekly.
Length of Treatment: Long-term use may be required.
Hydroxychloroquine for COVID-19
Note: Hydroxychloroquine has been studied for use in COVID-19, but its effectiveness remains under review. Always consult your healthcare provider for the most up-to-date information.
Chronic Discoid Lupus Erythematosus and Skin Lesions Associated with Lupus
Typical Dose: 200-400 mg daily.
Length of Treatment: Long-term use may be necessary.
Juvenile Idiopathic Arthritis
Typical Dose: 5-6.5 mg/kg daily, not exceeding 400 mg per day.
Length of Treatment: Long-term use may be required.
Sarcoidosis
Typical Dose: 200-400 mg daily.
Length of Treatment: Long-term use may be necessary.
Dosage Forms and Strengths
Hydroxychloroquine is available in the following dosage form:
- Tablet: 200 mg
Administration Instructions
Take hydroxychloroquine with food or milk to help prevent stomach upset. Swallow the tablet whole with a full glass of water. It is important to take this medication at the same time each day to maintain consistent levels in your body. If you miss a dose, take it as soon as you remember, but do not take two doses at once. Always follow your healthcare provider’s instructions carefully.
Hydroxychloroquine Side Effects
Like all medications, hydroxychloroquine may cause side effects. Some are more common than others, and certain side effects may require immediate medical attention. If you experience any side effects, contact your healthcare provider or one of our telemedicine providers promptly.
Common Side Effects
These may include nausea, vomiting, diarrhea, and stomach cramps. These side effects are generally mild and may improve as your body adjusts to the medication.
Less Common Side Effects
Headache, dizziness, and skin rashes can occur. If these symptoms persist or worsen, consult your doctor.
Serious Side Effects
Vision changes, such as blurred vision or difficulty focusing, may occur with long-term use. If you notice any changes in your vision, stop taking the medication and contact your healthcare provider immediately. Other serious side effects include muscle weakness, hearing loss, and mood changes.
Contraindications for Hydroxychloroquine
A contraindication is a specific situation or condition where a particular treatment or medication should not be used because it may cause harm. For hydroxychloroquine, there are several conditions where it is not safe to take the medication. These include:
Allergy to Hydroxychloroquine
If you have had an allergic reaction to hydroxychloroquine or similar medications, it is unsafe to take this drug. An allergic reaction could cause serious symptoms, including rash, swelling, or difficulty breathing.
Retinal or Visual Field Changes
Hydroxychloroquine can cause damage to the retina, the part of the eye responsible for vision. If you already have retinal or visual field problems, taking this medication could worsen your condition.
Heart Disease, Particularly Arrhythmias
Hydroxychloroquine can affect the heart’s electrical system, potentially leading to abnormal heart rhythms (arrhythmias). If you have a history of heart disease, especially arrhythmias, this medication could increase your risk of serious heart complications.
Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency
This is a genetic condition that affects red blood cells. Hydroxychloroquine can cause hemolysis (the breakdown of red blood cells) in people with G6PD deficiency, leading to severe anemia.
Psoriasis
Hydroxychloroquine can trigger or worsen psoriasis, a skin condition that causes red, scaly patches. If you have psoriasis, this medication may not be safe for you.
Myasthenia Gravis
This is a condition that causes muscle weakness. Hydroxychloroquine can exacerbate muscle weakness in individuals with myasthenia gravis.
Drug to Drug Interactions with Hydroxychloroquine
Hydroxychloroquine can interact with other medications, potentially leading to harmful effects. It’s important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Some common medications that may interact with hydroxychloroquine include:
- Digoxin (Lanoxin): Hydroxychloroquine can increase digoxin levels in the blood, which may lead to toxicity.
- Insulin or other antidiabetic drugs: Hydroxychloroquine can lower blood sugar levels, increasing the risk of hypoglycemia when taken with insulin or other diabetes medications.
- Antiepileptic drugs: Medications like phenytoin (Dilantin) and carbamazepine (Tegretol) may become less effective when used alongside hydroxychloroquine.
- Amiodarone (Pacerone): Both hydroxychloroquine and amiodarone can affect heart rhythm, raising the risk of serious arrhythmias.
- Azithromycin (Zithromax): Taking these medications together can increase the risk of heart rhythm disturbances.
- Cyclosporine (Neoral, Sandimmune): Hydroxychloroquine can raise cyclosporine levels in the blood, potentially leading to toxicity.
Hydroxychloroquine Use During Pregnancy
Is it safe to take hydroxychloroquine during pregnancy?
Hydroxychloroquine is generally considered safe during pregnancy, particularly for conditions like lupus and rheumatoid arthritis, where managing the disease is crucial for both the mother and baby. However, it’s essential to discuss your specific situation with your healthcare provider. They will carefully weigh the benefits and risks for you and your baby. If you are pregnant or planning to become pregnant, consider scheduling a telemedicine visit with one of our providers to review your treatment options.
Hydroxychloroquine and Breastfeeding
Is it safe to take hydroxychloroquine while breastfeeding?
Hydroxychloroquine is generally considered safe during breastfeeding. Although small amounts of the medication pass into breast milk, studies suggest it is unlikely to harm a nursing infant. However, it’s always best to consult your healthcare provider before starting or continuing hydroxychloroquine while breastfeeding. If you have any concerns, you can schedule a telemedicine appointment with one of our providers to discuss your options.
Estimated Cost of Hydroxychloroquine Medication
The cost of a 30-day supply of hydroxychloroquine without insurance can vary. However, with a GoodRx coupon, the price typically ranges from $10 to $20 for a standard dose of 200 mg tablets. Prices may differ depending on the pharmacy and location.
Possible Alternatives to Hydroxychloroquine
For certain conditions, alternative treatments or lifestyle changes may help manage symptoms. Always consult your healthcare provider before making any changes to your treatment plan. You can schedule a telemedicine visit with one of our providers to explore these options.
- Rheumatoid arthritis: Alternatives include methotrexate, sulfasalazine, or biologic agents like adalimumab (Humira). Physical therapy and regular exercise can also help manage symptoms.
- Lupus erythematosus: Corticosteroids, immunosuppressants like azathioprine (Imuran), and lifestyle changes such as sun protection and a healthy diet may be beneficial.
- Malaria: Other antimalarial medications, such as atovaquone/proguanil (Malarone) or doxycycline, may be used for prevention and treatment.
- Sjögren’s syndrome: Artificial tears, pilocarpine (Salagen), and lifestyle changes like staying hydrated can help manage symptoms.
- Porphyria cutanea tarda: Phlebotomy (blood removal) and avoiding alcohol or certain medications can help manage this condition.
- COVID-19: Hydroxychloroquine is no longer recommended for COVID-19 treatment. Consult your healthcare provider for current treatment options, which may include antiviral medications or monoclonal antibodies.
- Chronic discoid lupus erythematosus: Topical corticosteroids or immunosuppressive medications may be used as alternatives.
- Skin lesions associated with lupus: Topical treatments, sun protection, and immunosuppressive medications may help manage symptoms.
- Juvenile idiopathic arthritis: Methotrexate, biologic agents, and physical therapy are common alternatives.
- Sarcoidosis: Corticosteroids, methotrexate, or other immunosuppressants may be used to manage this condition.
Recent Updates on Hydroxychloroquine Research
Recent studies have shown that hydroxychloroquine is ineffective in treating or preventing COVID-19, and it is no longer recommended for this purpose. Ongoing research is focusing on the long-term safety of hydroxychloroquine, particularly its effects on the heart and eyes, especially with prolonged use. If you have concerns about the safety of hydroxychloroquine or questions about the latest research, schedule a telemedicine appointment with one of our providers to discuss how these findings may impact your treatment plan.
