Plaquenil (Hydroxychloroquine): Uses, Dosage, Side Effects & More

Summary of Key Points

Plaquenil (hydroxychloroquine) is frequently prescribed to manage autoimmune conditions such as lupus and rheumatoid arthritis, as well as for the prevention and treatment of malaria. It works by reducing inflammation and regulating the immune system. While it is generally well-tolerated, prolonged use can lead to side effects, including potential eye damage. Always consult your healthcare provider before starting or adjusting your dosage. You can also schedule a telemedicine appointment with us for personalized care.

Names of Medication

US Brand Name: Plaquenil

Generic Name: Hydroxychloroquine

The generic name, hydroxychloroquine, is the active ingredient in Plaquenil. It is often listed in parentheses next to the brand name.

Pharmacologic Category

Plaquenil falls under the following pharmacologic categories:

1. Antimalarial agent
2. Immunomodulator
3. Anti-inflammatory agent

Plaquenil Dosage

Plaquenil is prescribed for a variety of conditions, with the dosage and duration tailored to the specific illness being treated. Always follow your doctor’s instructions and consult them before making any changes to your medication. You can also schedule a telemedicine appointment with one of our providers for further guidance.

Plaquenil Dosage for Different Conditions

1. Lupus (Systemic Lupus Erythematosus): 200-400 mg daily, taken as a single dose or divided into two doses. Treatment is typically long-term to manage symptoms.
2. Rheumatoid Arthritis: 200-400 mg daily, taken as a single dose or divided into two doses. It may take several weeks to notice improvement, and treatment is often long-term.
3. Malaria Prevention: 400 mg once weekly, starting 1-2 weeks before exposure and continuing for 4 weeks after leaving the malaria area.
4. Malaria Treatment: 800 mg initially, followed by 400 mg at 6, 24, and 48 hours after the first dose.
5. Sjögren’s Syndrome: 200-400 mg daily, depending on symptom severity. Long-term treatment may be necessary.
6. Dermatomyositis: 200-400 mg daily, depending on symptom severity. Treatment duration varies based on response.
7. Systemic Sclerosis: 200-400 mg daily, depending on symptom severity. Long-term treatment may be required.
8. Antiphospholipid Syndrome: 200-400 mg daily, depending on symptom severity. Long-term treatment may be necessary.
9. Chronic Cutaneous Lupus Erythematosus: 200-400 mg daily, depending on symptom severity. Long-term treatment may be necessary.
10. Discoid Lupus Erythematosus: 200-400 mg daily, depending on symptom severity. Long-term treatment may be necessary.
11. Porphyria Cutanea Tarda: 200 mg daily for several months, depending on symptom severity. Treatment duration varies based on response.

Dosage Forms and Strengths

Plaquenil is available in the following dosage form:

1. Tablet: 200 mg

Administration Instructions for Plaquenil

Plaquenil should be taken with food or milk to minimize the risk of stomach upset. Swallow the tablet whole with a glass of water. It is important to take Plaquenil 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, unless it’s almost time for your next dose. Do not double up on doses. Always follow your doctor’s instructions for use.

Plaquenil Side Effects and Adverse Reactions

Like all medications, Plaquenil can cause side effects. Some are more common, while others are rare but potentially serious. If you experience any side effects, contact your healthcare provider immediately. You can also schedule a telemedicine appointment with us for further evaluation.

Common Side Effects of Plaquenil

Common side effects may include:

1. Nausea
2. Stomach pain
3. Headache

These side effects are generally mild and may improve over time.

Serious Side Effects of Plaquenil

1. Eye damage (retinopathy): Long-term use of Plaquenil can damage the retina, leading to vision problems. Regular eye exams are recommended.
2. Heart problems: Plaquenil can affect heart rhythm, potentially leading to arrhythmias. Seek medical attention if you experience chest pain or an irregular heartbeat.
3. Muscle weakness: In rare cases, Plaquenil can cause muscle weakness or nerve damage.

Contraindications for Plaquenil

A contraindication is a specific situation or condition where a particular medication should not be used because it may be harmful. If you have any of the following conditions, Plaquenil (hydroxychloroquine) may not be safe for you. Always consult your healthcare provider before starting or stopping any medication. If you have concerns, you can schedule a telemedicine appointment with one of our providers right away.

Conditions That May Contraindicate Plaquenil Use

1. Allergy to hydroxychloroquine or related medications: If you have had an allergic reaction to Plaquenil or similar medications like chloroquine, taking this medication could cause serious allergic reactions, including rash, swelling, or difficulty breathing.
2. Retinal or visual field changes: Plaquenil can cause or worsen retinal damage. If you have pre-existing eye conditions, especially retinal disorders, Plaquenil may not be safe for you.
3. Pre-existing heart conditions (especially arrhythmias): Plaquenil can affect heart rhythm, which may be dangerous for people with certain heart conditions, such as arrhythmias or prolonged QT interval. This could lead to severe complications like heart palpitations or fainting.
4. G6PD deficiency: People with glucose-6-phosphate dehydrogenase (G6PD) deficiency may experience severe hemolysis (breakdown of red blood cells) when taking Plaquenil, leading to anemia and other serious health issues.
5. Severe liver or kidney disease: Plaquenil is processed by the liver and kidneys. If you have severe liver or kidney disease, the medication may not be cleared from your body properly, leading to toxic levels.
6. Psoriasis or porphyria: Plaquenil can worsen these skin conditions, potentially leading to severe flare-ups.

Drug to Drug Interactions

Certain medications can interact with Plaquenil (hydroxychloroquine), potentially increasing the risk of side effects or reducing the effectiveness of one or both drugs. It’s important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Below are some common medications that may interact with Plaquenil:

1. Digoxin (Lanoxin): Plaquenil can raise digoxin levels in your blood, which may lead to toxicity and heart complications.
2. Insulin or other antidiabetic drugs: Plaquenil can lower blood sugar levels. If you’re taking insulin or oral diabetes medications, this could cause your blood sugar to drop too low, leading to hypoglycemia.
3. Antiepileptic drugs (e.g., phenytoin, carbamazepine): Plaquenil may reduce the effectiveness of these medications, increasing the risk of seizures.
4. Medications that prolong the QT interval (e.g., amiodarone, azithromycin): Taking Plaquenil with other drugs that affect heart rhythm can heighten the risk of dangerous arrhythmias.
5. Cyclosporine (Gengraf, Neoral): Plaquenil can increase cyclosporine levels, which may lead to toxicity.
6. Antimalarial drugs (chloroquine): Combining Plaquenil with other antimalarial medications can raise the risk of eye damage and other side effects.

Plaquenil in Pregnancy

Is it safe to take Plaquenil during pregnancy? The answer depends on your specific condition and the balance between the benefits and potential risks of continuing the medication. Plaquenil is sometimes prescribed during pregnancy to manage autoimmune conditions like lupus, as controlling the disease may outweigh potential risks to the baby. However, it’s crucial to discuss this with your healthcare provider. If you are pregnant or planning to become pregnant, consult with one of our telemedicine providers to determine the best course of action for both your health and your baby’s safety.

Plaquenil while Breastfeeding

Is it safe to take Plaquenil while breastfeeding? Plaquenil passes into breast milk in small amounts. The American Academy of Pediatrics generally considers Plaquenil safe during breastfeeding, especially for treating autoimmune conditions. However, it’s important to monitor your baby for any potential side effects, such as diarrhea or irritability. Always consult your healthcare provider before taking any medication while breastfeeding, and feel free to schedule a telemedicine visit with us to discuss your options.

Estimated Cost of Plaquenil Medication

The estimated cost of a 30-day supply of Plaquenil (200 mg tablets), taken twice daily, without insurance, ranges from $20 to $40 when using a GoodRx coupon. Prices may vary depending on your location and pharmacy. If you have concerns about the cost of your medication, our providers can help you explore alternatives or assist in finding discounts.

Possible Alternatives to Plaquenil

If Plaquenil is not suitable for you, or if you are seeking alternative treatments, there are other options available. Always discuss any changes to your treatment plan with your healthcare provider before making adjustments. You can also schedule a telemedicine appointment with us to explore these alternatives.

1. Lupus: Alternatives include corticosteroids (prednisone), immunosuppressants (azathioprine, methotrexate), or biologics (belimumab). Lifestyle changes, such as regular exercise, avoiding sun exposure, and maintaining a healthy diet, can also help manage symptoms.
2. Rheumatoid arthritis: Other disease-modifying antirheumatic drugs (DMARDs) like methotrexate, sulfasalazine, or biologics (etanercept, adalimumab) may be used. Physical therapy and anti-inflammatory diets can also be beneficial.
3. Malaria: Other antimalarial drugs, such as chloroquine, mefloquine, or doxycycline, may be prescribed depending on the region and resistance patterns.
4. Sjögren’s syndrome: Medications like pilocarpine or cevimeline can help with dry mouth symptoms, while artificial tears and eye drops can relieve dry eyes. Lifestyle changes, such as staying hydrated and using a humidifier, may also help.
5. Dermatomyositis: Corticosteroids, immunosuppressants (methotrexate, azathioprine), or intravenous immunoglobulin (IVIG) are common alternatives. Physical therapy is often recommended to maintain muscle strength.
6. Systemic sclerosis: Immunosuppressants like mycophenolate mofetil or methotrexate may be used. Lifestyle changes, such as avoiding cold exposure and using moisturizers, can help manage symptoms.
7. Antiphospholipid syndrome: Blood thinners like warfarin or low-dose aspirin are often used to prevent blood clots. Lifestyle changes, such as regular exercise and avoiding smoking, can also reduce the risk of complications.
8. Chronic cutaneous lupus erythematosus: Topical corticosteroids, immunosuppressants, or retinoids may be used. Sun protection and avoiding triggers like stress can help prevent flare-ups.
9. Discoid lupus erythematosus: Topical or oral corticosteroids, immunosuppressants, or retinoids may be prescribed. Sun protection is crucial to prevent skin damage.
10. Porphyria cutanea tarda: Phlebotomy (removal of blood) and low-dose hydroxychloroquine are common treatments. Avoiding alcohol and sun exposure can also help manage symptoms.

Recent Updates on Plaquenil Research

Recent studies have focused on the long-term safety of Plaquenil, particularly its effects on the eyes and heart. Research continues to explore optimal dosing strategies to minimize the risk of retinal toxicity, with some studies suggesting that lower doses may be safer for long-term use. Additionally, ongoing research is investigating the role of Plaquenil in treating COVID-19, though current evidence does not support its use for this purpose. As always, it’s important to consult with your healthcare provider before making any changes to your treatment plan. If you have questions about the latest research, our telemedicine providers are available to help guide you through the most up-to-date information.

James Kingsley

Learn More