Hydroxychloroquine (brand name Plaquenil®) is a foundational, first-line treatment for lupus that works as a disease-modifying anti-rheumatic drug (DMARD) to calm the overactive immune system, manage symptoms, and prevent long-term organ damage. It is recommended for nearly all lupus patients unless contraindicated.
If you've been diagnosed with lupus, your provider might prescribe hydroxychloroquine or another antimalarial drug. Hydroxychloroquine is the most commonly prescribed treatment for lupus, and most providers will put a patient who has lupus on this medication for the duration of their lives, not just during flare-ups.
Hydroxychloroquine typically is well tolerated. The most common side effects are nausea and diarrhea, which often improve with time. Other side effects include rash, hair changes, and muscle weakness. Rarely, hydroxychloroquine can lead to anemia, typically in individuals with G6PD deficiency or porphyria.
Hydroxychloroquine can be taken with other medications – NSAIDS (Celebrex®, ibuprofen, naproxen), prednisone, Enbrel®.
Concomitant administration of HCQ increased the bioavailability of metoprolol, as indicated by significant increases in the area under the plasma concentration-time curve (65 ± 4.6%) and maximal plasma concentrations (72 ± 6.9%) of metoprolol.
Cautions with other medicines
Metoprolol is used alone or in combination with other medications to treat high blood pressure. It also is used to treat chronic (long-term) angina (chest pain). Metoprolol is also used to improve survival after a heart attack.
These may include acetaminophen or aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. NSAIDs may produce side effects that worsen some lupus conditions, such as kidney disease, and so your doctor can advise you on how best to use these medications to treat your symptoms.
The usual dose for adults is 200mg to 400mg each day. If your child is prescribed hydroxychloroquine, their doctor will work out their dose based on their height and weight.
Methotrexate can cause serious side effects like low white blood cells and kidney problems, while hydroxychloroquine can cause heart rhythm issues and eye damage. Methotrexate is not safe during pregnancy, but hydroxychloroquine might be an option for rheumatoid arthritis during pregnancy.
There isn't specific research showing that HCQ causes gas in people with lupus. However, one study found that flatulence (gas) was a frequent side effect among people with osteoarthritis who were taking HCQ, along with other digestive issues, including nausea, vomiting, diarrhea, and loss of appetite.
Belimumab is a prescription medication that has been approved by the US Food and Drug Administration to treat SLE, and has been shown to reduce fatigue (ie, to increase vitality).
The early signs of hydroxychloroquine toxicity are macular edema and/or bilateral granular depigmentation of the RPE in the macula. With continued exposure to the drug, this can progress to an atrophic bull's-eye maculopathy with concentric rings of hypopigmentation and hyperpigmentation surrounding the fovea.
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.
Joint pain, swelling and stiffness can be the main symptoms for some people with lupus. In most cases, lupus is unlikely to cause permanent damage or change the shape of joints.
Once you and your doctor are sure the drug works for you, do not stop taking hydroxychloroquine without talking to your doctor. Symptoms of rheumatoid arthritis will return if you stop taking hydroxychloroquine.
HCQS 200 Tablet is an antimalarial medicine with anti-inflammatory and immunomodulatory properties. It is neither a steroid nor an opioid nor a painkiller.
Plaquenil works very slowly. In 1 to 3 months you should start to feel better. You may continue to get better for up to 1 year. Most people who take Plaquenil also take other medicines for pain and stiffness.
In sum, hydroxychloroquine intoxication is infrequent but potentially fatal, and should be suspected in cases of severe hypopotassemia associated to shock, ventricular arrhythmias or cardiopulmonary arrest of uncertain origin.
The medicines used most often to manage lupus include:
Lupus can attack many different parts of the body. Some call it the cruel mystery. Lupus is an autoimmune disease that can strike any part of the body, but the wide range of symptoms can be easily mistaken for something else.
SLE and other autoimmune disorders tend to run in families, but the inheritance pattern is usually unknown. People may inherit a gene variation that increases or decreases the risk of SLE, but in most cases do not inherit the condition itself.
This medicine may cause changes in blood sugar levels. Also, this medicine may cover up the symptoms of low blood sugar (including fast heartbeat) and increase the risk for serious or prolonged hypoglycemia (low blood sugar).
Atrial fibrillation is most often caused by changes to the heart's tissue or the electrical signaling that helps the heartbeat.
Beta blockers like bisoprolol, slow down your heart rate making it easier for your heart to pump blood around your body, which lowers your blood pressure. They can also make you feel dizzy at first. So, it's best to take your first dose at bedtime until you no longer feel dizzy, before switching to the morning.