Plaquenil

Generic name: Hydroxychloroquine sulfate

What is Plaquenil?

Plaquenil is prescribed for the prevention and treatment of certain forms of malaria.

Plaquenil is also used to treat the symptoms of rheumatoid arthritis such as swelling, inflammation, stiffness, and joint pain. It is also prescribed for lupus erythematosus, a chronic inflammation of the connective tissue.

What is the most important information I should know about Plaquenil?

Disorders of the retina causing impairment or loss of vision may be related to the length of time and the dose of Plaquenil given for lupus and rheumatoid arthritis. Problems have occurred several months to several years after beginning daily therapy. When you are on prolonged therapy, your doctor will perform eye examinations at the beginning of treatment and every 3 months after that. If you have any problem with your vision or your eyes, notify your doctor immediately.

All people on long-term therapy with Plaquenil should have a physical examination periodically, including testing of knee and ankle reflexes to detect any evidence of muscular weakness. Your doctor will also conduct periodic blood cell counts if you are on prolonged therapy with Plaquenil.

Children are especially sensitive to Plaquenil. Relatively small doses of Plaquenil have caused fatalities. Keep Plaquenil in a child-proof container and out of the reach of children.

Do not drive or perform other possibly unsafe tasks until you know how you react to Plaquenil; this medication may cause dizziness or blurred vision. These effects may be worse if you take it with alcohol or certain medicines.

If your symptoms do not improve after several months or if they become worse, check with your doctor.

Plaquenil may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Plaquenil. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.

Contact your health care provider if you notice any muscle weakness or problems with vision or hearing. Your knee and ankle reflexes will be tested periodically.

Who should not take Plaquenil?

If you are sensitive to or have ever had an allergic reaction to Plaquenil or similar drugs, such as chloroquine, you should not take Plaquenil. Make sure your doctor is aware of any drug reactions you have experienced.

Plaquenil should not be prescribed if you have suffered partial or complete loss of vision in small areas while taking Plaquenil or similar drugs. Notify your doctor of any past or present visual changes you have experienced.

This drug should not be used for long-term therapy in children.

What should I tell my doctor before I take the first dose of Plaquenil?

Tell your doctor about all prescription, over-the-counter, and herbal medication you are taking before beginning treatment with Plaquenil. Also, talk to your doctor about your complete medical history, especially the following: alcohol abuse, central nervous system, disease, digestive system disease, elevated blood acid levels, eye damage or visual changes due to hydroxychloroquine or chloroquine, glucose-6-phosphate dehydrogenase deficiency, kidney problems, liver disease, psoriasis (a recurrent skin disorder characterized by patches of red, dry, scaly skin), or porphyria (an inherited metabolic disorder affecting the liver or bone marrow).

What is the usual dosage?

The information below is based on the dosage guidelines your doctor uses. Depending on your condition and medical history, your doctor may prescribe a different regimen. Do not change the dosage or stop taking your medication without your doctor's approval.

Adults: One tablet of hydroxychloroquine sulfate, 200 mg, is equivalent to 155 mg base.

Children: One tablet of hydroxychloroquine sulfate, 200 mg, is equivalent to 155 mg base.

Acute Attack of Malaria

Adults: The usual starting dose is 800 milligrams (mg), to be followed by 400 mg in 6 to 8 hours and 400 mg on each of 2 consecutive days.

Alternatively, your doctor may prescribe a single dose of 800 mg.

Children 10 years and older: A total dose representing 25mg of base per kg of body weight is administered as follows:

First dose: 10 mg base per kg (but not exceeding a single dose of 620 mg base).

Second dose: 5 mg base per kg (but not exceeding a single dose of 310 mg base) 6 hours after first dose.

Third dose: 5 mg base per kg 18 hours after second dose.

Fourth dose: 5 mg base per kg 24 hours after third dose.

Lupus Erythematosus

Adults: The usual starting dose for adults is 400 mg once or twice daily. You will continue to take this dose for several weeks or months, depending on your response. For longer-term maintenance therapy, your doctor may reduce the dose to 200 to 400 mg per day.

Restraint or Prevention of Malaria

Adults: The usual dose is 400 mg taken once every 7 days on exactly the same day of each week. If circumstances permit, preventive therapy should begin 2 weeks prior to exposure. If this is not possible, your doctor will have you take a starting dose of 800 mg, which may be divided into 2 doses taken 6 hours apart. You should continue this suppressive therapy for 8 weeks after leaving the area where malaria occurs.

Rheumatoid Arthritis

Adults: The usual starting dose for adults is 400 to 600 mg a day taken with a meal or a glass of milk. If your condition improves, usually within 4 to 12 weeks, your doctor will reduce the dose to a maintenance level of 200 to 400 milligrams daily.

Should a relapse occur after medication is withdrawn, therapy must be resumed or continued on an intermittent schedule if there is no other reason why Plaquenil cannot be used in this particular patient.

Suppression of Malaria

Children 10 years and older: The weekly suppressive dosage is 5mg, calculated as base, per kg of body weight, but should not exceed the adult dose regardless of weight. Suppressive therapy should begin 2 weeks prior to supposed exposure. If suppressive therapy does not begin 2 weeks prior to exposure, 10mg base per kg should be taken in two divided doses 6 hours apart. Suppressive therapy should be continued for 8 weeks after leaving the area where malaria is present.

This drug has not been proved safe for treatment of juvenile arthritis.

How should I take Plaquenil?

Take Plaquenil exactly as prescribed for the full course of therapy.

If you have been prescribed Plaquenil for rheumatoid arthritis, it will take several weeks (4 to 12 weeks) for beneficial effects to appear. Take each dose with a meal or a glass of milk.

Take Plaquenil by mouth with food or a glass (8oz. or 240ml) of milk. If possible, preventative measure for malaria should begin 2 weeks prior to exposure and be continued for 8 weeks following your departure from the infected area.

What should I avoid while taking Plaquenil?

Use caution when driving or performing other hazardous activities until you know how this medication affects you. Plaquenil may cause visual disturbances such as blurred vision, misty vision, and difficulty focusing. Report any vision or hearing changes to your doctor.

Avoid the sun, sunlamps, or tanning booths until you know how you react to Plaquenil. Plaquenil may cause you to become sunburned more easily. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.

What are possible food and drug interactions associated with Plaquenil?

If Plaquenil is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Plaquenil with the following: any medication that may cause liver damage, aurothioglucose, cimetidine, and digoxin.

What are the possible side effects of Plaquenil?

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking this drug.

Side effects of treatment for an acute malarial attack may include: abdominal cramps, diarrhea, dizziness, heart problems, lack or loss of appetite, mild headache, nausea, vomiting

Side effects of treatment for lupus erythematosus and rheumatoid arthritis may include: abdominal cramps, abnormal eye pigmentation, acne, anemia, bleaching of hair, blind spots, blisters in mouth and eyes, blood disorders, blurred vision, convulsions, decreased vision, diarrhea, difficulty focusing the eyes, diminished reflexes, dizziness, emotional changes, excessive coloring of the skin, eye muscle paralysis, vision problems, headache, hearing loss, heart problems, hives, involuntary eyeball movement, irritability, itching, light flashes and streaks, light intolerance, liver problems or failure, loss of hair, loss or lack of appetite, muscle paralysis, muscle weakness and wasting, nausea, nervousness, nightmares, psoriasis (dry, scaly, red skin patches), reading difficulties, ringing in the ears, skin eruptions, skin inflammation and scaling, skin rash, vertigo, vomiting, extremem fatigue, weight loss

Can I receive Plaquenil if I am pregnant or breastfeeding?

Use of Plaquenil during pregnancy should be avoided except in the suppression or treatment of malaria when, in the judgment of your doctor, the benefit outweighs the possible risks. This drug may appear in breast milk and could affect a nursing infant. If Plaquenil is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.

What should I do if I miss a dose of Plaquenil?

Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and only take your next regularly scheduled dose. Do not take a double dose of this medication.

How should I store Plaquenil?

Store at room temperature in a tightly closed container, away from heat, moisture, and light. Do not store in the bathroom.