Hydroxychloroquine

• While taking hydroxychloroquine you should see your rheumatologist or other specialist regularly to make sure the treatment is working and to minimise any possible side effects.
• You may need regular blood tests as suggested by your rheumatologist.
• It is important to tell your rheumatologist if you have a new serious illness such as a serious infection, cancer or heart failure.
• If you are worried about any side effects, you should contact your rheumatologist as soon as possible.
• If you stop hydroxychloroquine for any reason, you must contact your doctor.
• If you plan to become pregnant, you must discuss the timing with your nominated doctor/rheumatologist.

Hydroxychloroquine does not work straight away. It may take 8 to 12 weeks for symptoms to start to improve. The full effect of treatment may take up to 26 weeks.

Other medicines may be given to improve your symptoms while waiting for hydroxychloroquine to work.

Hydroxychloroquine is taken by mouth in tablet form. 

Take this medicine with a full glass of water at the same time each day. The tablets have a bitter taste so it may be best to take it with food.
If you miss a dose, take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
 

What is the dosage?

The usual dose is one tablet (200mg) once or twice a day. Tablets can be taken altogether, once a day. The dose may be reduced to a maintenance dose after a few months once a response is achieved. 

Hydroxychloroquine may be used with other arthritis medicines including:

• other DMARDs such as methotrexate
• steroid medicines such as prednisolone or cortisone injections into the joint
• anti-inflammatory medicines (NSAIDs) such as naproxen (Naprosyn) and ibuprofen (Brufen, Nurofen)
• simple pain medicines such as paracetamol.

Tell your doctor if you are taking any other medicines, including medicines that you buy at the chemist, supermarket or health food shop.

How long is treatment continued?

Treatment with hydroxychloroquine may be continued long-term if it works well and no serious side effects occur.

If you stop hydroxychloroquine treatment for more than a few weeks there is a risk that your condition may worsen. Continue with your treatment unless advised by your doctor or unless side effects develop.

You might experience side effects with your treatment. Tell your doctor if you are concerned about possible side effects. 

Most common possible side effects

• This list includes the more common side effects of hydroxychloroquine, they are usually mild and short lived:
  • Vision changes
  • Nausea/vomiting
  • Diarrhoea
  • loss of appetite
  • Abdominal cramps
  • Itch
  • Headache.

Less common or rare possible side effects

• Contact your doctor if you suspect one of these less common/rare side effects
  • Thinning of the hair, skin rashes and increased sensitivity to the sun. It is a good idea to wear sunscreen and a hat when in the sun. The medication may rarely worsen psoriasis rash.
  • Hydroxychloroquine may rarely cause increased skin pigmentation. 
  • Hydroxychloroquine may very rarely cause temporary blurring of vision due to deposits in the front of the eye (cornea). In its early form it is usually reversible when the medicine is stopped. You should report to your doctor any visual disturbances, (blurred vision, mist or fog before the eyes or light sensitivity).
  • More serious eye problems involving the retina (back of the eye) are extremely rare. These occur mainly in people taking a high dose for longer than 5 years, or in those who have liver or kidney problems. Your doctor will advise you about what eye testing is required.
  • Ringing in the ears
  • Abnormal weakness of the leg muscles
  • Changes in the way your heart beats.

Eye testing

• When you start treatment with hydroxychloroquine your doctor will discuss your vision and may ask you to have an eye test. This eye test may be repeated during your treatment to monitor effects on your eyesight.
• Most patients should have an eye test around the time of starting hydroxychloroquine and then annually after five years of treatment has passed.
• Wear sunglasses when in bright sunlight.

Use with other medicines

• Hydroxychloroquine can interact with other medicines. You should tell your doctor (including your GP, rheumatologist and others) about all medicines you are taking or plan to take. This includes over the counter or herbal/naturopathic medicines. You should also mention your treatment when you see other health professionals.
• Most vaccines can be given safely. Talk with your rheumatologist before receiving any vaccines.

Use with alcohol

• You don’t need to avoid alcohol while taking hydroxychloroquine. However, it’s strongly advised not to drink more than 4 standard drinks at one time, even if it’s only occasional.

Use in pregnancy and breastfeeding

• If you intend becoming pregnant, or if you conceive while taking hydroxychloroquine, or if you are breastfeeding, you should discuss this with your doctor.
• Hydroxychloroquine can be used in pregnancy if the mother’s condition is serious, however you should ask your doctor about the benefits and risks of taking hydroxychloroquine while you are pregnant.
• More detailed information is available here.

• Store hydroxychloroquine in a cool, dry place, away from direct heat and light (e.g. not in the bathroom).
• Keep all medicines out of reach of children.