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Hydroxychloroquine for Rheumatoid Arthritis – most common questions ?

Hydroxychloroquine is a common medication used for patients with rheumatoid arthritis. This medication can be used alone or in combination with other medications. When I start my patients on this therapy here are the most common questions that I clarify for patients.

  • What is Hydroxychloroquine/Plaquenil?
  • What is the effect of Hydroxychloroquine in Rheumatoid Arthritis Patients?
  • Is Hydroxychloroquine a pill or an injectable medication?
  • What are the most common side effects?
  • Can Hydroxychloroquine be combined with other medications such as biologics?
  • How common is Hydroxychloroquine to affect the eyes?
  • Can Hydroxychloroquine affect other organs?
  • Can I get vaccinated while taking Hydroxychloroquine?
  • Is Hydroxychloroquine safe for pregnancy?

Let’s begin !

What is Hydroxychloroquine/Plaquenil?

Hydroxychloroquine is a common medication used in patients with rheumatoid arthritis. Thus, this medication is used for modulation of the immune system and decreasing inflammation. Plaquenil is the brand name of Hydroxychloroquine.

What is the effect of Hydroxychloroquine in Rheumatoid Arthritis Patients?

Patients with rheumatoid arthritis have high levels of inflammation. Inflammation may be systemic (affecting many organs) and, or in the joints. Hydroxychloroquine inhibits locomotion of neutrophils which are cells that are going to the inflammation site and release more substances that will increase inflammatory response.

Is Hydroxychloroquine a pill or an injectable medication?

Hydroxychloroquine is an oral therapy. Plaquenil comes as tablets of 200 mg; generic hydroxychloroquine comes in 100 mg, 200 mg, 300 mg, and 400 mg tablets.

Hydroxychloroquine should be administered with food. To improve tolerability of hydroxychloroquine, dividing doses, taking with food, and/ or gradual dose escalation may be suggested by your physician.

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What are the most common side effects?

Here are listed the most common side effects reported by patients on Hydroxychloroquine:

  • Gastrointestinal issues including nausea, vomiting, and diarrhea
  • Hypersensitivity reactions
  • Retinopathy
  • Hemolysis, or breakdown or destruction of red blood cells
  • Skeletal muscle myopathy including decreased tendon reflexes and abnormal conduction
  • Hypoglycemia (low blood sugar level)
  • Weakness
  • Nervous system symptoms including dizziness, fatigue, headache, and irritability

Can Hydroxychloroquine be combined with other medications such as biologics?

Yes, Hydroxychloroquine can be combined with other DMARDs such as methotrexate, leflunomide, sulfasalazine or biologic therapies. Always consult a rheumatologist to discuss the therapy that may be suitable for your case.

 

How common is Hydroxychloroquine to affect the eyes?

Ophthalmic issues occur in 1%-10% of treatments and retinopathy has a frequency rate of 4%. Retinal toxicity is dose dependent and may occur in long-term treatments of hydroxychloroquine. Retinopathy may lead to decreased visual acuity, peripheral vision, and night vision. Retinopathy is most commonly seen 5 or more years after the start of treatment. That is why, I always recommend an eye exam for baseline, before you start therapy.

How to monitor if Hydroxychloroquine is safe for your body?

Baseline and periodic tests (CBC with differential, liver and renal panel function) should be done for monitoring therapy. An ophthalmologic (eye) exam should be taken at baseline and annually beginning at five years. ECG, muscle therapy and serum electrolytes should also be monitored and electrolytes should be corrected for any imbalances.

Can Hydroxychloroquine affect my organs?

Hydroxychloroquine can affect the skin causing hypopigmentation after sun exposure. Rarely, at high doses and long term therapy, this medication can affect the heart such as arrhythmias (QT prolongation), syncope or heart failure. Liver injury has been seen although it is extremely rare. Those with hepatic impairment should proceed with caution.

Can I get vaccinated while taking Hydroxychloroquine?

Yes, vaccinations are recommended for all patients with rheumatoid arthritis (e.g. flu vaccine, shingles vaccine and pneumococcal vaccine) preferably before starting therapy. Vaccines can also be given while taking therapy with hydroxychloroquine.

Is Hydroxychloroquine safe for pregnancy?

Hydroxychloroquine is SAFE for those planning to become pregnant. However, pregnancy should be planned during a period of low disease activity. Hydroxychloroquine may have adverse impacts on male fertility but is recommended for use in those with rheumatoid arthritis who plan to father a child. Hydroxychloroquine can be detected in cord blood at delivery. Infant outcome and data collection to monitor pregnancy in hydroxychloroquine treatment is still ongoing. Breastfeeding while on therapy with hydroxychloroquine is considered acceptable.

If you have symptoms of rheumatoid arthritis or you are interested to discuss your therapy, Rheumatologist OnCall is happy to offer you a consultation that will discuss all the aspects of your disease and therapy. 

DISCLAIMER

This medication information is limited. Patients should use it as a tool to better understand the medication role in the disease treatment. It is not supposed to be comprehensive and does NOT include all information about a diagnosis, treatment, medication, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a physician. Patients must speak with their physician for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. 

 

Authors

Diana M. Girnita is a rheumatologist and founder and CEO, Rheumatologist OnCall. She can also be reached on FacebookInstagram, and YouTube.

 

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