Plaquenil and its use in lupus treatment

I know many people who have benefitted from Plaquenil, my previous rheumatologist even it called it “a great drug to control symptoms of lupus.  However, I cannot take Plaquenil because of my initial reaction to it when it was first prescribed to me.  However, what does not work for me can work wonderfully for other people, so I always advise people to do extensive research on any drug they are prescribed, before you take it, if possible.  I find it is very important to prepare yourself for any side effects before you take any drug, so that you are not caught off guard.  I have also had to decline medication because I felt that the risks and the possible side effects far outweighed its benefits, which is a right that every patient has.  Educate yourself about every aspect of your treatment plan, it is your right and you have to be your best advocate.  Here is some information about Plaquenil and feel free to comment below about your personal experience with it.

DESCRIPTION

Hydroxychloroquine (Plaquenil) is considered a disease-modifying anti-rheumatic drug (DMARD) because it can decrease the pain and swelling of arthritis, and it may prevent joint damage and reduce the risk of long-term disability.

WHAT ARE DMARDs

What do they do?

Each disease-modifying anti­rheumatic drug (DMARD) works in different ways to slow or stop the inflammatory process that can damage the joints and internal organs.

Who are they for?

Doctors prescribe DMARDs for people with inflammatory arthritis who are at risk of permanent joint damage. Most of the DMARDS in this chart are approved for rheuma­toid arthritis. Some are also approved for ankylosing spondylitis, psoriatic arthritis, juvenile inflammatory arthritis and lupus. Some DMARDs – for example, cyclophosphamide and mycopheno­late mofetil (CellCept) – are reserved for people with diseases with the potential to cause severe organ damage, such as lupus or vasculitis.

What’s important to know about the drug class?

DMARDs, particularly methotrexate, are often prescribed with other DMARDs or biologics. This is called combina­tion therapy. While DMARDs can be effective in slowing or modifying the disease process, they do not work quickly. You will need to take them consis­tently for weeks or even months before you notice their beneficial effects. Your doctor may prescribe an NSAID and/or corticosteroid with a DMARD, at least initially until the DMARD takes effect.

Before taking DMARDs (and any medication), always tell your doctor if you have an active infection, high blood pressure or a history of kidney or liver disease. Also talk to your doctor before getting any vaccines.

While taking DMARDs, it is important to be aware of any signs of infection – chills, fever, sore throat, painful urination, for example – and report them to your doctor immediately. Some drugs require that you have laboratory tests to monitor for side effects.

FAST FACTS

  • Hydroxychloroquine often is used for mild rheumatoid arthritis or in combination with other drugs for more severe disease.
  • Hydroxychloroquine is commonly used to manage multiple complications of lupus and connective tissue disorders.
  • Hydroxychloroquine is a relatively safe medication, though monitoring by an ophthalmologist is recommended while taking this drug.

USES

Hydroxychloroquine is in a class of medications that was first used to prevent and treat malaria. Today it is used to treat rheumatoid arthritis, some symptoms of lupus, juvenile rheumatoid arthritis, and other autoimmune diseases, though these diseases are not caused by malaria parasites.

HOW IT WORKS

It is not clear why hydroxychloroquine is effective at treating autoimmune diseases. It is believed that hydroxychloroquine interferes with communication of cells in the immune system.

DOSING

Hydroxychloroquine generally is given to adults in doses of 200 mg or 400 mg per day. In some cases, higher doses can be used.

TIME TO EFFECT

Symptoms can start to improve in 1-2 months, but it may take up to 6 months before full benefits of this medication are experienced.

SIDE EFFECTS

Hydroxychloroquine typically is very well tolerated, and serious side effects are rare. The most common side effects are nausea and diarrhea, which often improve with time or by taking the medication with food. Less common side effects include skin rashes, changes in skin pigment (such as darkening or dark spots) or hair changes (bleaching or thinning of hair), and weakness. Rarely, hydroxychloroquine can lead to anemia in some individuals.

In rare cases, hydroxychloroquine has caused visual changes or loss of vision, but such vision problems are more likely to occur in individuals taking high doses for many years, in persons 60 years or older, or in those with significant kidney disease. The dose used today is lower than the one originally used to treat arthritis or malaria. At the current recommended dose, development of visual problems while taking this medication is extremely unusual.

POINTS TO REMEMBER

Although vision problems and loss of sight while taking hydroxychloroquine for the treatment of lupus or arthritis are very rare, notify your doctor if you notice any changes in your vision. Your doctor also may suggest regular eye exams while taking this medication. Visual changes experienced by the patient early on or seen early during regular eye exams usually improve after stopping the medication.

If you are pregnant or are considering having a child, discuss this with your doctor before taking this medication. Although hydroxychloroquine use might be safe during pregnancy, any medication taken during pregnancy should be discussed with a doctor.

DRUG INTERACTIONS

Although there are few drug interactions with hydroxychloroquine, to be safe be sure to tell your doctor about all of the medications you are taking, including over-the-counter drugs and natural remedies.

INFORMATION TO DISCUSS WITH YOUR PRIMARY CARE PHYSICIAN AND OTHER SPECIALISTS

Be sure to notify your other physicians that you are taking this drug. This drug does not have a strong effect on the immune system, so vaccines recommended by other physicians are generally acceptable. Be sure to notify your ophthalmologist that you are taking this medicine so you can have the correct visual screening tests.

FOR MORE INFORMATION

The American College of Rheumatology has compiled this list to give you a starting point for your own additional research. The ACR does not endorse or maintain these Web sites, and is not responsible for any information or claims provided on them. It is always best to talk with your rheumatologist for more information and before making any decisions about your care.

National Institutes of Health: Medline Plus

www.nlm.nih.gov/medlineplus/druginfo/meds/a601240.html

ACR Position Statement on screening for hydroxychloroquine retinopathy

www.rheumatology.org/practice/clinical/position/hydroxy.pdf

Lupus Foundation of America on Anti-Malarials in Lupus

www.lupus.org/webmodules/webarticlesnet/templates/new_aboutaffects.aspx?articleid=87&zoneid=17

Updated April 2012

Written by Michael Cannon, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee.

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