Lupus Foundation of America Greater Ohio Chapter Logo
GREATER OHIO CHAPTER

Toll Free: 1 (888) NO-LUPUS | Phone: (440) 717-0183

Help Us Solve The Cruel MysteryTM

Donate To The Ohio Chapter

Everything You Need to Know About Hydroxychloroquine for Lupus  

Fitting into the class of medications that can be used to effectively manage more than one condition, hydroxychloroquine (Plaquenil) is an antimalarial drug that has proven to be effective in the management of lupus as well. Originally developed and still used to treat malaria, the medication was first prescribed as a treatment for lupus in 1834 and was approved by the US Food and Drug Administration (FDA) for the same use in 1954. Today, hydroxychloroquine is considered the first line of treatment for patients with systemic lupus erythematosus (SLE), neonatal lupus, and cutaneous lupus. Hydroxychloroquine is generally not used in the treatment of drug-induced lupus since the primary course of treatment, in that case, is the discontinuation of the medication.

When hydroxychloroquine is appropriate

If you’ve been diagnosed with lupus, your provider might prescribe hydroxychloroquine or another antimalarial drug. Hydroxychloroquine is the most commonly prescribed treatment for lupus, and most providers will put a patient who has lupus on this medication for the duration of their lives, not just during flare-ups.

Dosing for hydroxychloroquine

The dose for hydroxychloroquine is usually 6.5 milligrams per kilogram, which means somebody who weighs 200 pounds would take 590 milligrams of hydroxychloroquine per day. This dose may change depending on a number of factors. If you gain or lose weight, you’ve recently been diagnosed, or your kidneys are failing, the dose may be adjusted to accommodate. Hydroxychloroquine should always be taken with food to prevent nausea, vomiting, or diarrhea.

Hydroxychloroquine: Benefits for lupus patients

When prescribing a new medication, providers consider the benefits of the medication against the risks it poses to the patient. Hydroxychloroquine can be very beneficial in the treatment of lupus, which is why it’s prescribed more often than any other treatment. The most impactful benefits include:

  • delayed ultraviolet light absorption, which can prevent flares
  • fewer lupus flare-ups/reduction in the number of flares
  • reduced organ and tissue damage from lupus over time
  • reduced antigen-presenting cell count in the skin
  • protection against bone loss, the formation of blood clots, and irreversible organ damage

Hydroxychloroquine can also prevent flares during pregnancy without harming the fetus, making it a viable treatment option for pregnant women. Perhaps most notable is the study that found that lupus patients who take hydroxychloroquine live longer on average than lupus patients who don’t take the medication. When it’s right for you, adding hydroxychloroquine to your treatment plan can quite literally add years to your life.

Side effects of hydroxychloroquine

All medications and supplements are accompanied by potential side effects. The most common side effects associated with hydroxychloroquine are nausea, vomiting, diarrhea, upset stomach, and cramping, and these usually subside after the first few days to a week once your body adjusts. Other less common side effects include headache, tiredness, weakness, and loss of appetite, and these, too, typically subside the longer you take the medication.

Retinal toxicity is a very rare, serious adverse event associated with hydroxychloroquine. To monitor for vision changes that might indicate retinal toxicity, all patients should schedule a baseline eye exam with dilation during their first year or treatment and then an annual exam moving forward. This can’t prevent toxicity, but it can identify the signs of retinal toxicity early and give the care team the opportunity to intervene before serious damage occurs.

Retinal toxicity is more likely to occur when a patient has been prescribed a higher dose than recommended for more than five years straight. It’s also more likely in patients who have severe renal or hepatic compromise, retinal dystrophy, macular degeneration, or previous use of hydroxychloroquine.

Obesity can also increase risk as body weight is used to calculate the dose and the drug does not accumulate in fat. This means that an obese patient is more likely to receive a larger dose than necessary, one of the risk factors for developing retinal toxicity.

Precautions and drug interactions

Hydroxychloroquine may interact with other medications, including penicillamine and remdesivir. Because of the way the medication works in your body, it’s also essential that your doctor knows about any other medical history or conditions you have, including glucose-6-phosphate dehydrogenase deficiency-G6PD, alcohol abuse, porphyria, kidney disease, vision problems, diabetes, seizures, or hearing problems. It’s also imperative that you share any allergies to foods or medications with both your healthcare team and your pharmacy. Your provider will take into consideration your medical history, the risks posed by untreated lupus, and other factors when determining the safest and most effective treatment plan for you.

If you’re already taking hydroxychloroquine and you start a new medication or are diagnosed with a new condition, be sure to let that provider know that you’re taking hydroxychloroquine as well.

Taking hydroxychloroquine during pregnancy

While studies have shown that hydroxychloroquine doesn’t harm the fetus, the drug should only be taken during pregnancy if the benefits outweigh the risks, a decision that is left to the physician and patient based on the seriousness of the disease. Additionally, this medication does pass through the breast milk, so you should visit with your doctor about the pros and cons of breastfeeding while taking hydroxychloroquine.

Other medications used in the treatment of lupus

While hydroxychloroquine is the most commonly prescribed medication for the treatment of lupus, other medications may be utilized in lieu of hydroxychloroquine or in addition to it. Those medications include:

  • Anti-inflammatory medications like ibuprofen, indomethacin, or Naprosyn, which can help reduce inflammation and pain in the body. In the mildest cases of lupus, anti-inflammatory drugs alone may be enough to control symptoms and prevent damage.
  • Benlysta, a medication approved in 2011 that blocks a protein involved in the attack against the body that occurs with lupus.
  • Corticosteroids like prednisone can quickly reduce symptoms and protect against organ damage. Steroids are often accompanied by a myriad of unwanted side effects that are only used when absolutely necessary.
  • Immunosuppressant drugs suppress your immune system to prevent it from continuing its attack on healthy tissue. These medications put you at higher risk of infection, so taking preventative measures and notifying your provider of fever or other symptoms right away is vital.
  • Other antimalarials. While hydroxychloroquine is used most often because it’s less likely to produce side effects, other antimalarials are sometimes used in lieu of hydroxychloroquine when indicated.

    Fitting into the class of medications that can be used to effectively manage more than one condition, hydroxychloroquine (Plaquenil) is an antimalarial drug that has proven to be effective in the management of lupus as well. Originally developed and still used to treat malaria, the medication was first prescribed as a treatment for lupus in 1834 and was approved by the US Food and Drug Administration (FDA) for the same use in 1954. Today, hydroxychloroquine is considered the first line of treatment for patients with systemic lupus erythematosus (SLE), neonatal lupus, and cutaneous lupus. Hydroxychloroquine is generally not used in the treatment of drug-induced lupus since the primary course of treatment, in that case, is the discontinuation of the medication.

Skip to content