HCQ has been shown to decrease SLE activity, especially in mild and moderate disease, to prevent disease flare and to lower the long-term glucocorticoid need. The numerous benefits of HCQ are extended to pregnancy and breastfeeding period.
Hydroxychloroquine and other antimalarials
Doctors use antimalarials to treat malaria, but these medicines can also treat lupus by: Reducing pain and inflammation. Preventing lupus flares and helping with lupus skin problems.
Hydroxychloroquine starts to work gradually. For inflammatory conditions such as rheumatoid arthritis and lupus, it can take 6 to 12 weeks before you notice any benefits. It's important to keep taking hydroxychloroquine. You may not feel any different at first, but it is likely to be working.
Your lupus symptoms should start to improve within 1 to 3 months after you start hydroxychloroquine. It takes about 6 months to feel the full benefits. After a few months on hydroxychloroquine, your doctor will examine you and see how well it's working to control symptoms like joint swelling and pain.
Plaquenil and other anti-malarials are the key to controlling lupus long term, and some lupus patients may be on Plaquenil for the rest of their lives.
Jorge and colleagues assessed hospitalizations for lupus flares in a larger cohort of patients across the Mass General Brigham network. They again found that using less than 5 mg/kg/day of HCQ compared to more was associated with a higher risk, this time, of hospitalization for a lupus flare.
Serious side effects
muscle weakness, cramps, stiffness or spasms, or changes in how your skin feels such as tingling. frequent infections with a high temperature, sore throat or mouth ulcers. bruising that happens more easily than usual.
How long you take hydroxychloroquine for depends on why you're taking it. For some conditions, if hydroxychloroquine works for you then you may need to take it for several years, or even for the rest of your life, to control your symptoms.
As with all medicines, some people may experience side effects from taking hydroxychloroquine. The most important side effect of hydroxychloroquine is on the eye. Blurred vision may occur in the first few weeks after starting hydroxychloroquine. This usually returns to normal even when you continue taking the tablets.
This medicine may cause muscle and nerve problems. Check with your doctor right away if you have muscle weakness, pain, or tenderness while using this medicine. Hydroxychloroquine may cause some people to be agitated, irritable, or display other abnormal behaviors.
No clinical trial has reported that Hydroxychloroquine can make you gain weight. However, bloating or weight gain can be experienced by some people because of water or fluid retention in the body. You should inform your physician if you experience severe or unusual weight change.
Flares are an unfortunate part of living with lupus, but lifestyle changes can reduce your risk of flares. Eating a healthy diet, exercising regularly, avoiding stress, and staying out of the sun will help.
Drugs that suppress the immune system may be helpful in serious cases of lupus. Examples include azathioprine (Imuran, Azasan), mycophenolate (Cellcept), methotrexate (Trexall, Xatmep, others), cyclosporine (Sandimmune, Neoral, Gengraf) and leflunomide (Arava).
In 2020 and 2021, two new drugs (anifrolumab and voclosporin) were approved for the treatment of lupus or lupus nephritis; and a third one, belimumab (previously approved for the treatment of lupus), was approved for the treatment of lupus nephritis.
Its main side effects are gastrointestinal upset (vomiting, diarrhea, stomach cramps), skin rash, headache, dizziness, and ocular toxicity. However, serious side effects including arrhythmia, bronchospasm, angioedema, and seizures can rarely occur.
Long-term use and high doses of hydroxychloroquine are risk factors for the development of cardiomyopathy. Cardiac failure, conduction disorders (including QT prolongation and Torsades de Pointes) and sudden cardiac death are consequences of the cardiomyopathy.
Because it's a long-term treatment it's important to keep taking hydroxychloroquine unless you have severe side effects: even if it doesn't seem to be working at first. even when your symptoms improve (to help keep the disease under control).
Hydroxychloroquine acts by suppressing Toll-like receptors to trigger important immunomodulatory effects. Hydroxychloroquine is a well-established and effective therapy for systemic and cutaneous lupus and other autoimmune diseases.
Hydroxychloroquine is generally safe at normal doses, but higher amounts can damage the retina, the light-sensitive tissue at the back of the eye, and could result in partial or complete blindness.
40 % of women by age 50 will develop female pattern hair loss. This means that 40 % of female patients who use Plaquenil will develop female genetic hair loss - not from the drug itself but because that is the expected frequency in the population.
Can Plaquenil have effects on my teeth? No, side effects related to teeth weren't reported in Plaquenil's clinical studies.
Hydroxychloroquine may potentially result in adverse effects on the central nervous system, mainly irritability, nervousness, emotional changes, nightmares, and even true psychoses [3, 4].