Plaquenil (Hydroxychloroquine) for Lupus

What is Plaquenil (Hydroxychloroquine)?

Plaquenil is most known for its original purpose: treating and preventing malaria. Malaria is a disease caused by parasites that can enter the body through a mosquito bite.

The essential ingredient, known as quinine, is derived from the bark of the cinchona plant. Quinine, same as what is found in small amounts in tonic water, have been found to have health benefits beyond being an antimalarial including pain relief.

The original use of quinine dates back at least to the 1600s in South America. But, the use of the drug expanded in part due to observations made during World War II. Many people were using quinine (or synthetic versions of it) to prevent malaria. Doctors noticed that rheumatic symptoms improved when taking quinine, which led to the use of medications like Plaquenil to combat lupus, rheumatoid arthritis (RA), and other autoimmune conditions.

The name “quinine” is derived from Quechua, the language of the Inca in Peru. The native Quechuan word, quina or quina-quina, translates as “bark of bark” or “holy bark.”

Type: DMARD

DMARD stands for disease-modifying antirheumatic drugs. These types of drugs have the impact of slowing down disease progression.

Need-to-know Plaquenil Info

Before you begin taking any medication, you should have an open and honest conversation with your doctor about all aspects of your lupus (if you haven’t already!).

Long-term use of Plaquenil is associated with damage to the retina in the eye, the portion of the eyeball that is sensitive to light. It is important to see an ophthalmologist before starting Plaquenil to establish a baseline. And, you should have regular eye screenings the entire time you take the medication. While eye damage only occurs in about 1 in 5,000 people that take the drug for at least 5 years, it is important to monitor.

It is crucial that you do NOT smoke while taking Plaquenil, or other antimalarial medications. Smoking reduces the effectiveness of the medication. And, smoking is not recommended for anyone, particularly those with a higher risk of cardiovascular disease.

To prevent upset stomach, take Plaquenil with food. Also, the generic version of Plaquenil, hydroxychloroquine, can cause additional stomach irritation. If you are experiencing consistent stomach aches, it may be useful to talk to your doctor about taking the brand-name alternative.

You can take antimalarials during pregnancy, but it is important to speak with your doctor regarding adjusting your lupus treatment plan if you become pregnant. Not all medications taken for lupus are approved for use if you are pregnant.

Of note: While you may experience benefits of the medication at 1 month, it can take up to 3 months for the benefits to be fully realized.

The Plaquenil label information from the FDA is available here.

How does Plaquenil help me battle lupus?

Antimalarials are able to help modulate the immune system. And, they have the additional benefit of not making your body more susceptible to infection (a noted side effect of many other lupus medications).

The Johns Hopkins Lupus Center reports:

“Anti-malarial medications may prevent activation of plasmacytoid dendritic cells, a component of the immune system that is responsible for making interferon.”

Despite this, the FDA label still states that the mechanisms underlying the anti-inflammatory and immunomodulatory effects of the drug are unknown.

Side Effects of Plaquenil

Antimalarial medications are typically well tolerated. Nearly 90% of people will not experience any side effects from these types of medications.

Call your doctor right away if you notice any of these side effects:

• Blurred vision or changes in your vision
• Convulsions, seizures, or other neurological symptoms (these are very rare)
• Muscle aches or weakness
• Nervousness or anxiety
• Headaches

If you notice these less serious side effects, talk with your doctor:

• Dry skin
• Loss of appetite
• Upset stomach or cramps
• Diarrhea
• Bleaching of hair or hair loss
• Blue-back discoloration of skin, fingernails, or inside of the mouth

A full list of known side effects can be found here.

Starting Plaquenil

Plaquenil is sold in 200mg tablets.

The recommended adult dosage for a person with lupus is 200 to 400 mg daily. It can be taken in two doses or at one time. Doses above 400 mg/day are not recommended.

It is possible to overdose on Plaquenil as it is rapidly and completely ignored upon ingestion. Toxic symptoms may occur within 30 minutes. Symptoms of overdose include:

• headache
• drowsiness
• visual disturbances
• cardiovascular collapse
• convulsion
• respiratory and/or cardiac arrest

Drug interactions with Plaquenil

A total of 226 drugs are known to interact with Plaquenil, including 8 major drug interactions. For a full list that can be easily searched, visit drugs.com

You should avoid taking antacids or Kaopectate within 4 hours of taking Plaquenil. Some antacids may make it harder for your body to absorb the medication.

Some of the medications that may interact with Plaquenil include:

• Arava (lefunomide)
• Aurolate (gold sodium thiomalate)
• Aubagio
• Ferriprox
• Mellaril
• Sabril

Cost

Benlysta is a relatively inexpensive medication that is likely covered, at least in part, by insurance.

Using GoodRx, the estimates for 60 200mg tablets are:

Generic hydroxychloroquine: $54

Brand name Plaquenil: $400

Lupus and Plaquenil research

While Plaquenil was not created with the explicit purpose of helping people minimize the disease activity of lupus, a number of clinical trials have been conducted to examine the clinical impact of the medication.

One such study found that Plaquenil “has a protective effect on survival” which is evident even when considering for other treatment variables. Additionally, the study confirmed that the medication was well tolerated by the participants.

This study examined people that were part of the LUMINA cohort. LUMINA stands for: LUpus in MInorities: NAture vs nurture. As the name suggests, this cohort is made up of people of various ethnicities.

There were 608 participants in the trial. The ethnic breakdown was:

• 117 Hispanics from Texas
• 101 Hispanics from Puerto Rico
• 220 African-Americans
• 170 Caucasians

An additional finding of the study was that patients treated with Plaquenil tended to have less severe disease activity.

Because previous studies have found strong connections between Plaquenil and decreased lupus flares, the amount of damage to the body, and the favorable impact on survival, the researchers deemed it to be unethical to conduct a double-blind, placebo study. Instead, the researchers used statistical models to create two groups based on the likelihood of a patient being prescribed Plaquenil after accounting for disease severity and socio-demographic factors.

It is by comparing these two groups that the researchers could conclude that Plaquenil provided a statistically beneficial protective effect on survival both on its own and in conjunction with other lupus medications. The researchers made this determination using odds ratios — these are a measure of the association between an exposure (in this case, taking Plaquenil) and an outcome (here, survival).

The researchers concluded that these positive outcomes, and the limited side effects, make Plaquenil a powerful force in the fight against lupus. The researchers suggest that Plaquenil, “should be considered as a therapeutic option in all patients with SLE and should be administered using established guidelines so that the proper dose is prescribed (not exceeding 6.5 mg/kg of (ideal) body weight) and adequate ophthalmological monitoring is performed.”