ANA, Anti-malarial drug, Anti-rheumatic drug, Arthritis, Autoimmune Disease, c3, c4, connective tissue disease, Double dtranded DNA, lupus, mixed connective tissue disease, Rheumatic diseases, Scleroderma, Sjogren's Syndrome, ssa, SSB, undifferentiated connective tissue disease
This is an anti-malarial drug that is used primarily to treat:
– Systemic Lupus
– Rheumatoid Arthritis
Hydroxychloroquine (Plaquenil) is started at 6.5 mg/kg of the ideal body weight to no more than 400 mg per day. The usual doses are between 200 to 400 mg daily either once a day or twice daily. The dose should be reduced in liver and kidney disease.
Eye exams are required in patients starting Plaquenil. Patient should have eye examination before starting Plaquenil and then every six to twelve months for as long as taking this treatment.
This treatment is generally well-tolerated. Half life of this drug is 32-50 days. This treatment should be stopped if not effective after six months. Toxicity does increase after five years and it is rare before that. Therefore I usually reduce the dose to 200 mg daily as condition becomes stable and as tolerated. I have even reduced the dose to 2-3 times per week in many patients.
The use in pregnancy is classified as category C where one need to look at risks and benefits in each individual case. It is found in breast milk but amount is very small.
Precautions should be taken in patients with Psoriasis and Porphyria as it may exacerbate these conditions. G6PD deficiency may result in renal failure and hemolysis.
7. Presence of liver disease, kidney disease, obesity, and being older than 70 years of age all increase risk of Plaquenil toxicity. More information here.