Many may not understand how Hydroxychloriquine (Plaquenil) can help lupus warriors. There are three anti-malarial drugs that are prescribed for lupus symptoms. Hydroxychloroquine (Plaquenil) is the most commonly prescribed because it is generally believed to cause fewer side effects; chloroquine (Aralen) has a reputation for more serious side effects, but it may be prescribed in situations where hydroxychloroquine cannot be used. Quinacrine (Atabrine) is another alternative, but it is prescribed less often because it can sometimes cause a yellow discoloration of the skin. It is sometimes given in addition to hydroxychloroquine if the patient does not respond to Plaquenil alone. Quinacrine tablets are no longer manufactured and can only be obtained through a compounding pharmacist. Your doctor will advise you on how to obtain quinacrine if this becomes your advised method of treatment.
Treating Lupus with Anti-Malarial Drugs
- Hydroxychloroquine (Plaquenil)
- Chloroquine (Aralen)
- Quinacrine (Atabrine)
What are anti-malarial drugs, and why are they used to treat lupus?
Hydroxychloroquine (Plaquenil), chloroquine (Aralen), and quinacrine (Atabrine) are medications that were originally used to prevent or treat malaria. However, during World War II it was also found that these medications were effective in treating the symptoms of lupus. Specifically, anti-malarial medications have shown to improve muscle and joint pain, skin rashes, pericarditis (inflammation of the lining of the heart), pleuritis (inflammation of the lining of the lung), and other lupus symptoms such as fatigue and fever. These medications may also prevent lupus from spreading to certain organs, such as the kidney and central nervous system (your brain and spinal cord) and may help to reduce flares by as much as 50%. 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. For this reason, you can think of anti-malarials as a sort of “lupus life insurance.”
Hydroxychloroquine is taken in tablet form, with or after food.
A doctor will advise you about the correct dose. Usually you will start on a full dose of 200–400 mg daily, and later your doctor may reduce this. When your condition is very well controlled you may be advised to take hydroxychloroquine only 2–3 times per week.
Hydroxychloroquine doesn’t work immediately. It may be 12 weeks or longer before you notice any benefit. 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).
Side effects and risks
Side effects aren’t usually common. However, in some people hydroxychloroquine can cause:
- skin rashes, especially those made worse by sunlight
- feeling sick (nausea) or indigestion
- diarrhea
- headaches
- bleaching of the hair or mild hair loss
- tinnitus (ringing in the ears)
- visual problems.
There’s a small risk that hydroxychloroquine can damage a part of the inside of the eye called the retina. And this increases with long-term use and higher dosage.
Research has shown that your risk of developing retinopathy is higher the longer you are taking Plaquenil. In fact, the incidence of retinal toxicity rises sharply in people that have taken it between 5 and 7 years. As a result, baseline testing should occur within the first year of taking the drug and then annually at the five-year mark. Personally, we recommend a full evaluation every 18-24 months during the first five years and then annually after five years.
It is recommended that every single person on Hydroxychloriquine (Plaquenil) get a visual field 10-2 test, plus one of the three other highly sensitive screening tests: the FAF (fundus autofluorescence imaging), the SD-OCT (spectral domain optical coherence), or the multifocal electroretinogram (mfERG)
Sources: https://www.hopkinslupus.org/lupus-treatment/lupus-medications/antimalarial-drugs/
https://www.versusarthritis.org/
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