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Hydroxychloroquine (Plaquenil)

What is hydroxychloroquine?
Hydroxychloroquine is an antimalarial drug. It is also useful in Rheumatoid Arthritis and Lupus.
How long will it take to work?
Hydroxychloroquine usually takes 6 to 8 weeks to start working in Rheumatoid arthritis. Evidence suggests that there is significant improvement in the number of swollen, tender joints in rheumatoid arthritis patients with hydroxychloroquine *.
What dose of Hydroxychloroquine will I have to take?
The daily dose of Hydroxychloroquine is 200 mg. Depending on the severity of your arthritis, your Rheumatologist may prescribe a dose of 2 tablets of 200mg daily.
What should I discuss with my Rheumatologist before
starting Hydroxychloroquine?
Before starting Hydroxychloroquine, tell your Rheumatologist if you have any of the following --
  • Allergic reaction to Hydroxychloroquine or chloroquine in the past.
  • Any eye problem.
  • Glucose-6-phosphatase (G6PD) deficiency.
  • Porphyria.
  • Psoriasis.
Can Hydroxychloroquine be taken in pregnancy?
Please talk to your rheumatologist if you are pregnant/planning pregnancy.
Can Hydroxychloroquine be taken while breast feeding?
Always talk to your Rheumatologist before taking Hydroxychloroquine while you are breast feeding.
What should I do if I miss a tablet?
Missing an ocassional dose will not cause any problem. Take the next dose as usual.
What are the usual side effects of hydroxychloroquine?
Stomach upset, heartburn, allergic reaction, itching, rash, vision problems, over-pigmentation of skin
What tests do I need to have?
You need to have a fundoscopy (an eye test). This is done as a very small number of patients taking chloroquine/ hydroxychloroquine can have trouble with the retina of the eye. American College of Rheumatologists recommends the eye examination within 1 year of starting Hydroxychloroquine.
How common is the retinal problem with
It is a rare occurrence. Over 1,00,000 patients have received hydroxychloroquine till date. There have been only 20 cases of retinal toxicity with the recommended dose (< 6.5mg/kg/ day). These cases had taken it for more than 5 years. Thus retinal problems are very rare in the first few years with the routine low doses **.
Is there any test for early detection of retinal problems?
Amsler’s grid is a useful test for early detection of retinal problems. Have your amsler’s grid for home monitoring.
How can one avoid over-pigmentatin of skin with hydroxychloroquine?
It tends to affect the skin pigmentation in a few individuals. Over pigmentation (darkening of the skin) can occur & should be brought to notice of your Rheumatologist. You can reduce the chances of over-pigmentation by wearing a full-sleeve dress/ a sun screen & an umbrella when in the sun.

* Suarez-Almazor ME, Belseck E, Shea B, et al. Antimalarials for rheumatoid arthritis. In: The Cochrane Library, Issue 2, 2002.

** American College of Physicians -- (PDF File)

Further clinical evidence about the role of hydroxychloroquine in Rheumatoid arthritis can be found at

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Created on: April 2007
Last updated on: Feb 2015
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