Side effects of hydroxychloroquine

Plaquenil

Plaquenil is the brand name for the prescription drug hydroxychloroquine.

It’s used to treat and prevent malaria infection, and to reduce symptoms and progression of autoimmune diseases such as lupus, rheumatoid arthritis, and others.

Malaria is spread by mosquitoes, which transmit the parasites that cause the infection, usually in tropical and subtropical parts of the world.

Plaquenil is used to treat other types of infections too. For example, it may be combined with an antibiotic to treat chronic Q-fever, which humans usually catch from farm animals or raw milk.

The drug may be used to treat a type of blood disease called porphyria cutanea tarda, although it’s only used in certain cases because it can worsen symptoms.

Plaquenil is in a class of medicines known as antimalarials. It’s a less toxic version of the older antimalarials, including quinine and chloroquine.

The drug is also in a group of biologic medicines known as disease-modifying anti-rheumatic drugs (DMARDs), because of its effects on autoimmune illnesses, which develop when your body’s disease-fighting system starts to turn against your healthy cells.

Medical researchers are exploring the use of Plaquenil for additional illnesses, including other autoimmune conditions, skin disorders, some cancers, and heart, blood, and infectious diseases.

Plaquenil was originally approved by the Food and Drug Administration (FDA) in 1955.

Plaquenil Warnings

Before taking Plaquenil, tell your doctor if you have or have ever had:

  • Liver disease
  • Psoriasis
  • Any blood disorders, such as porphyria, glucose-6-phosphate dehydrogenase deficiency (G6PD), or others
  • Dermatitis
  • A vision disorder
  • Effects on your hearing caused by drugs

You should also tell your doctor if you drink large amounts of alcohol.

In rare cases, Plaquenil can cause cardiomyopathy, a chronic disease of the heart muscle.

If you’re taking Plaquenil for an autoimmune condition, your symptoms should begin to improve after a few months, but it can take up to six months for full effects.

Stop taking the medicine and call your doctor if your symptoms worsen or don’t improve.

Plaquenil and Children

Plaquenil can be dangerous to children, who are particularly sensitive to the drug. Kids shouldn’t take Plaquenil as a long-term treatment.

Overdose can be fatal in children. So you should keep Plaquenil out of their reach.

Plaquenil and Eye Problems

Plaquenil can cause serious vision problems that aren’t always reversible.

Tell your doctor immediately if you notice any changes in vision or if you’ve ever had vision changes while taking chloroquine (Aralen) or primaquine.

If you’re taking this medicine for a long period of time, your doctor will probably recommend annual eye exams.

Pregnancy and Plaquenil

It’s not known whether Plaquenil will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant before using this drug.

Malaria is more likely to cause death if you are pregnant. Talk to your doctor about the risks of traveling to areas where malaria is more common if you are pregnant.

It’s not known whether Plaquenil passes into breast milk or could harm a breastfeeding baby. Talk to your doctor before breastfeeding while taking this medicine.

Question

I have a mild form of rheumatoid arthritis serum positive, treated with Plaquinel 400mg daily and Naproxan 1000mg daily for the past 6 years. I have had no problems with the arthritis in all that time and still don’t. My question is about the Plaquinel. This summer I started having skin discoloration on the top of both of my feet. The color of my skin turned a deep blackish blue color. Could this be caused by the Plaquinel and a reaction with sunbathing? Since being out of the sun the blackish blue color has faded but I can still see some discoloration in areas. How can I find out for sure if this is caused by my meds? And if it is caused by Plaquinel is skin discoloration reason enough to stop taking it? Having a mild disease I would hate to go onto stronger meds unless it is necessary.

Answer

Plaquenil or hydroxychloroquine has been known to cause a darkened discoloration of skin and/or mucous membranes. This is considered an adverse reaction and should be discussed with your prescriber. It is important to evaluate this color change to make sure there is nothing else wrong.

Thinking about drinking? Read this first

Most people enjoy an occasional happy hour with co-workers and friends. But what if you have lupus?

We asked two members of our Medical-Scientific Advisory Council for their help in developing some guidelines. Here’s what they had to say:

1. Meds don’t mix

“When people with lupus drink, the most important considerations are alcohol-medication interactions, effects on the liver, and increased risk of GI (gastrointestinal tract) bleeding,” says Karen H. Costenbader, MD, MPH, Associate Professor of Medicine at Brigham & Women’s Hospital and Harvard University Medical School Section of Rheumatology. She says that people with lupus especially need to be aware of these alcohol-medication interactions:

  • First and foremost, mixing alcohol and pain medicines can be fatal. If you’re taking medications to manage your pain, talk to your doctor or pharmacist about any reactions that may result from drinking alcohol.
  • If you are taking methotrexate, leflunomide, mycophenolate mofetil, or other drugs that are metabolized in the liver, you should not drink any alcohol at all, due to increased risk of irreversible cirrhosis (liver scarring and failure).
  • Certain drugs may not be as effective if you are drinking alcohol; in particular, anticoagulant medicines such as warfarin (Coumadin®).
  • Prednisone and non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Motrin®), naproxen (Naprosyn®), and celecoxib (Celebrex®) increase risk of GI bleeding, and so does alcohol, so drinking adds increased risk.

2. Know when to say, “No, thanks.”

“Unfortunately, lupus affects very young women,” says Eliza F. Chakravarty, MD, MS, Arthritis and Clinical Immunology Associate Member, Oklahoma Medical Research Foundation in Oklahoma City, “so I have a lot of very young women patients who say, ‘I don’t go out with my friends because they always pressure me to drink alcohol and I just don’t feel good.’ I tell them, ‘Hey, make me the bad guy. Tell your friends, ‘My doctor says I need to get 10 hours of sleep so I can’t stay out past 10 p.m.’, or ‘my doctor says I can’t drink because of my disease,’ or ‘I can’t drink because of my medicine.’”

3. Offer other options

Chakravarty suggests to her patients that they follow that up with an invitation of their own. “Tell your friends, “I’d still like to go and hang out with you for a while—let’s have lunch or get coffee and catch up,’ or, ‘Hey, can you guys just come over to my house and watch a movie?’ That way, you’re staying engaged socially, but you’re not faced with activities that you physically are just not up to.”

4. Make mine a mocktail!

And remember: You don’t have to drink to stay social: you can always enjoy a nonalcoholic “mocktail” in a fancy glass. Add a twist, a little paper umbrella, and a few good stories, and see if you aren’t the life of the party! There are plenty of great mocktail recipes online, check out our favorites at AllRecipes.com.

What is Hydroxychloroquine (Plaquenil®)?

Hydroxychloroquine is used in the treatment of arthritis to help relieve inflammation, swelling, stiffness, and joint pain and also to help control the symptoms of lupus erythematosus (lupus; SLE). A common brand name for hydroxychloroquine is Plaquenil®. This medicine was originally used to prevent and to treat malaria.

How do I take it?

Hydroxychloroquine is usually taken twice daily. The pills are 200-mg. each. The usual dose is 1 or 2 pills daily. This medicine should be taken at the same time every day. It will take 1 to 2 months to begin working. Follow your doctor’s directions. Do not take more or less medicine than ordered. This medicine should be taken with food or milk.

What about other medications?

When you are taking Hydroxychloroquine, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements.

Hydroxychloroquine can be taken with other medications – NSAIDS (Celebrex®, ibuprofen, naproxen), prednisone, Enbrel®.

What else should I know?

Rarely, Hydroxychloroquine can cause vision problems. Your doctor may want you to have an eye exam before beginning this medication. You will then have an eye exam yearly with an ophthalmologist to check for any changes in the back of the eye. Notify your doctor if you experience any blurred vision or see black spots.

Hydroxychloroquine tablets

What is this medicine?

HYDROXYCHLOROQUINE (hye drox ee KLOR oh kwin) is used to treat rheumatoid arthritis and systemic lupus erythematosus. It is also used to treat malaria.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Plaquenil, Quineprox

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

  • diabetes

  • eye disease, vision problems

  • G6PD deficiency

  • history of blood diseases

  • history of irregular heartbeat

  • if you often drink alcohol

  • kidney disease

  • liver disease

  • porphyria

  • psoriasis

  • seizures

  • an unusual or allergic reaction to chloroquine, hydroxychloroquine, other medicines, foods, dyes, or preservatives

  • pregnant or trying to get pregnant

  • breast-feeding

How should I use this medicine?

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. Avoid taking antacids within 4 hours of taking this medicine. It is best to separate these medicines by at least 4 hours. Do not cut, crush or chew this medicine. You can take it with or without food. If it upsets your stomach, take it with food. Take your medicine at regular intervals. Do not take your medicine more often than directed. Take all of your medicine as directed even if you think you are better. Do not skip doses or stop your medicine early.

Talk to your pediatrician regarding the use of this medicine in children. While this drug may be prescribed for selected conditions, precautions do apply.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

Do not take this medicine with any of the following medications:

  • cisapride

  • dofetilide

  • dronedarone

  • live virus vaccines

  • penicillamine

  • pimozide

  • thioridazine

  • ziprasidone

This medicine may also interact with the following medications:

  • ampicillin

  • antacids

  • cimetidine

  • cyclosporine

  • digoxin

  • medicines for diabetes, like insulin, glipizide, glyburide

  • medicines for seizures like carbamazepine, phenobarbital, phenytoin

  • mefloquine

  • methotrexate

  • other medicines that prolong the QT interval (cause an abnormal heart rhythm)

  • praziquantel

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Tell your doctor or healthcare professional if your symptoms do not start to get better or if they get worse.

Avoid taking antacids within 4 hours of taking this medicine. It is best to separate these medicines by at least 4 hours.

Tell your doctor or health care professional right away if you have any change in your eyesight.

Your vision and blood may be tested before and during use of this medicine.

This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

  • allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue

  • changes in vision

  • decreased hearing or ringing of the ears

  • redness, blistering, peeling or loosening of the skin, including inside the mouth

  • seizures

  • sensitivity to light

  • signs and symptoms of a dangerous change in heartbeat or heart rhythm like chest pain; dizziness; fast or irregular heartbeat; palpitations; feeling faint or lightheaded, falls; breathing problems

  • signs and symptoms of liver injury like dark yellow or brown urine; general ill feeling or flu-like symptoms; light-colored stools; loss of appetite; nausea; right upper belly pain; unusually weak or tired; yellowing of the eyes or skin

  • signs and symptoms of low blood sugar such as feeling anxious; confusion; dizziness; increased hunger; unusually weak or tired; sweating; shakiness; cold; irritable; headache; blurred vision; fast heartbeat; loss of consciousness

  • uncontrollable head, mouth, neck, arm, or leg movements

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

  • anxious

  • diarrhea

  • dizziness

  • hair loss

  • headache

  • irritable

  • loss of appetite

  • nausea, vomiting

  • stomach pain

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children. In children, this medicine can cause overdose with small doses.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from moisture and light. Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

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