Plaquenil is considered an older disease-modifying anti-rheumatic drug or DMARD. Plaquenil is actually in a class of medications called anti-malarials but it is also used to treat rheumatic and autoimmune conditions which are unrelated to malaria. It's important to know about safety warnings associated with plaquenil so undesirable side effects can be minimized.
1 - Plaquenil (hydroxychloroquine) is prescribed to patients who cannot tolerate newer biologic DMARDs.
Plaquenil is a DMARD which has been prescribed for years to rheumatoid arthritis patients as well as patients with lupus, juvenile rheumatoid arthritis, and other autoimmune diseases. When the newer biologic DMARDs began receiving FDA-approval in 1998 and subsequent years, it seemed plaquenil would become less prescribed. The drug still has a place for patients who try and fail biologics, cannot tolerate biologics, or for those who fear trying the newer biologic DMARDs.
2 - Plaquenil is prescribed as a disease-modifier, in other words, to decrease pain, decrease swelling, and prevent joint damage and disability.
It is not known how plaquenil works but researchers believe that plaquenil interferes with communication between cells within the immune system.
3 - The usual starting dose of plaquenil is 200 mg twice a day or 400 mg once a day.
The usual dosage works for most patients taking plaquenil but it is possible to increase or decrease the dose based on individual needs. It's important to watch for possible side effects and toxicity.
4 - Plaquenil, being a DMARD, is a slow-acting drug.
Patients taking plaquenil may begin to notice improvement after one or two months. It can take up to six months before full benefits of plaquenil are realized.
5 - Plaquenil is generally well-tolerated but side effects are possible.
Side effects associated with plaquenil are categorized as common, less common, and rare. The common side effects which are linked to plaquenil use include nausea and diarrhea. Taking the medication with food can solve that for most patients. Less common side effects which may be tied to plaquenil include skin rashes, hair thinning, and weakness. A rare side effect of plaquenil involves visual changes or loss of vision.
6 - The rare side effect which affects vision, known as hydroxychloroquine retinopathy, if caught early, may improve after plaquenil is stopped. It is not always reversible though.
Since the side effect of vision loss is so rare it is important to tell your doctor about any changes you notice to your vision. Some doctors recommend regular eye exams while on plaquenil to catch early changes. Once abnormalities are discovered, toxicity has occurred.
7 - Certain patients are more susceptible to potential vision problems associated with plaquenil than others.
Once again, vision changes from plaquenil are rare, but certain people are at higher risk for developing the problem. High risk patients would include those who:
- took high doses of plaquenil for years
- are 60 years or older
- have known kidney disease
8 - All individuals starting plaquenil treatment should have a baseline opthalmologic examination within the first year.
If the patient's initial opthalmologic examination is normal and the patient is considered low risk, re-testing need not occur for five years. It is recommended that high risk patients have annual eye examinations.
9 - Certain drugs may interact with plaquenil, affecting how it works or causing it to be less effective. Tell your doctor about every medication and supplement you are taking.
Drugs which may interact with plaquenil include:
- botulinum toxins
- magnesium trisilicate
10 - If you are pregnant or considering becoming pregnant, discuss plaquenil with your doctors.
Though plaquenil might be safe during pregnancy, it is recommended that effective birth control be used throughout the course of plaquenil treatment and up to six months after treatment is stopped.
Hydroxychloroquine (Plaquenil). American College of Rheumatology.
Screening for Hydroxychloroquine Retinopathy. Position Statement from American College of Rheumatology. May 2006.
Hydroxychloroquine. Patient Education. Drugs A-Z.