Plaquenil

What is Plaquenil?

Plaquenil can be used in order to prevent or treat malaria, a disease that is caused by parasites that get into the body via the bite of mosquitoes. Hydroxychloroquine isn't effective against all malaria strains and also against malaria in regions in which the disease has become resistant to another similar drug, chloroquine.

Plaquenil is also used to alleviate symptoms of rheumatoid arthritis and discoid arthritis, as well as systemic Lupus erythematosus.

Warnings

Plaquenil may cause serious consequences for the heart, specifically if you are also taking other medications like Z-Pak, the anti-inflammatory azithromycin. Get medical attention immediately when you experience rapid or rapid heartbeats, as well as sudden dizziness (like you may pass through).

The use of Plaquenil long-term or at high doses can cause irreparable injury to your retinal eyes that may lead to permanent vision issues.

Take a break from Plaquenil and contact your doctor immediately if you experience fuzzy vision, difficulty getting your focus, blurred vision or blind spots, difficulty reading, changes to your color vision, or increased sensitivity to light.

Before you start taking this medicine

It is recommended not to take Plaquenil if you have an allergy to chloroquine or hydroxychloroquine.

Long-term use or high doses of Plaquenil could cause irreparable damage to the retina (the membrane inside the eye that creates vision). The damage could cause permanent vision issues. The risk of damage to the retina is greater in those who have a preexisting eye problem or kidney disease than in those who take Tamoxifen.

To be sure Plaquenil is safe for you, ask your physician if you've ever suffered from:

• Vision loss as well as damage to the retina due to the use of an anti-malaria drug;
• Heart disease and cardiac rhythm disorders (such as long qt syndrome);
• Diabetes;
• A stomach disorder;
• A reaction in the body to the chemical quinine;
• Kidney disease or liver failure;
• Psoriasis;
• Alcoholism;
• Porphyria (a genetic disorder of enymes that results in symptoms affecting the nervous system, skin, or nerves) or
• A genetic enzyme deficiency called glucose-6-phosphate dehydrogenase (g6pd) deficiency.

Inform your physician if you are expecting or planning to be pregnant. The risk of malaria is higher and can cause severe disease or even death for pregnant women. Having malaria during pregnancy could also increase the chance of stillbirth, miscarriage, premature birth, and a low birth weight. If you're pregnant, then your name might be included on an OB-GYN registry to track any effects of the hydroxychloroquine on the infant.

It isn't known if it will affect the unborn child. If you're expecting, talk to your doctor about the dangers of going to areas where malaria is prevalent (such as Africa, South America, and Southern Asia). It is not recommended to breastfeed while taking Plaquenil. Talk to your doctor regarding any risks. Plaquenil is not approved to treat the symptoms of lupus or rheumatoid arthritis in people less than 18 years old.

Similar or related drugs

Simponi, Saphnelo, aspirin, prednisone, amoxicillin, doxycycline, and methotrexate

What should I do to take Plaquenil?

You should take Plaquenil exactly as directed by your physician. Follow the directions on the prescription label and study all medication guides or instructions sheets. Follow the medication exactly as prescribed.

Take Plaquenil in conjunction with food or a glass of milk, unless your doctor recommends otherwise. Don't crush or break a tablet made of Plaquenil. To treat arthritis or lupus, Plaquenil is usually taken every day.

To avoid the spread of malaria Plaquenil can be taken every week at the exact time every week. Begin taking the medicine two weeks prior to arriving in a region where malaria is a common occurrence. Continue to take the medicine throughout your stay and until at least four weeks after you leave the region. To combat the malaria problem, Plaquenil can be administered in one dose, then in smaller doses over the following two days.

Make sure to take this medication for the entire prescribed duration, even if symptoms do not improve immediately. Get in touch with your doctor as quickly as you can after having had exposure to malaria or if you experience fever or other signs of illness after or during your stay in a region that is prone to malaria.

Make sure to wear the appropriate clothes, insect repellents, and mosquito nets on your bed to protect yourself from mosquito bites that can cause malaria.

There is no medication that is 100 percent efficient in preventing or treating all malaria types. Discuss with your doctor if you are experiencing an increase in fever or diarrhea, vomiting, or diarrhea while you are taking your medication.

When you are using Plaquenil, it is possible that you might require frequent examinations of your eyes and medical tests. Maintain at room temperature, free of heat, moisture, and light.

Details on dosage

Usual Adult Dose of Plaquenil for Malaria Prophylaxis:

400 mg of salt (310 mg of base) daily, orally

Dosing on the basis of weight: 6.5 mg/kg salt (5 mg/kg base) daily, once or twice a week.
Maximum dose: 400 mg salt (310 mg base)/dose

Comments:
This drug must be given on the same day every week.
The treatment for immunosuppression should start 2 weeks before exposure and be continued for 4 weeks following departure from the area of endemicity.

Use: To prevent the spread of malaria in geographical regions where resistance to chloroquine is not known.

US CDC Recommendations: 310 mg base (400 mg salt) daily, once or twice a week.

Comments:
An alternative to chloroquine for prophylaxis only in areas with chloroquine-sensitive malaria
The treatment should begin at least 2 weeks prior to departure for areas of malaise. It should be maintained every week (same day every week) during the time you are in the malarious area and for a period of 4 weeks following having left the area.
If you notice that malaria occurs while taking this medication for chemoprophylaxis, it shouldn't be used as part of the treatment plan.
The current guidelines should be read for more details.

Usual Adult Dose of Plaquenil for Malaria:

800 mg of salt (620 mg basis) in a single oral dose, and then 400 mg of salt (310 mg basis) at 6, 24, and 48 hours following the dose initial
Total dose: 2000 mg salt (1550 mg base)

Weight-based dosing:
The first dose is 13 mg/kg salt (10 mg/kg base) orally.
Second dose (6 hours following the first dosage): 6.5 mg/kg salt (5 mg/kg base) orally
Third dose (24 hours following the first dosage): 6.5 mg/kg salt (5 mg/kg base) orally
Fourth dose (48 hours after the first dosage): 6.5 mg/kg salt (5 mg/kg base) orally

Maximum Dose:
First dose: 800 mg salt (620 mg base)/dose
Third, second, and fourth doses 4 mg sodium (310 mg base)/dose

Comments:
A concurrent treatment with an 8-aminoquinoline-based compound is required to treat the underlying cause of Plasmodium virax and P. ovale-related infections.

Use: To treat malaria that is not complicated due to P falciparum, malariae, P ovale, and P vivax.

US CDC Recommendations: 620 mg base (800 mg salt) all at once orally, and then 300 mg base (400 mg salt) orally at 6, 24, and 48 hours.
Total dose: 1550 mg base (2000 mg salt)

Comments:
Recommended for mild malaria (P falciparum or species that are not recognized) in areas with chloroquine susceptibility
recommended for uncomplicated malaria (P malariae, P knowlesi, P vivax [unless chloroquine-resistant P vivax is suspected], or P ovale) in all regions; if treating P vivax or P ovale infections, concomitant treatment with primaquine (after quantitative testing to rule out glucose-6-phosphate dehydrogenase [G6PD] deficiency) is recommended.
Recommend malaria treatment that is not complicated for women who are pregnant in areas that have chloroquine susceptibility.
Current guidelines should be reviewed for further details.

Usual Adult Dose of Plaquenil for Systemic Lupus Erythematosus:

200-400 mg of salt (155 to 300 mg base) per day taken orally, divided into one or two doses

Comments:
Doses of more than 400 mg per day are not recommended.
A higher incidence of retinopathy has been reported in cases where this maintenance dose is exceeded.

Uses: To treat chronic discoid lupus and systemic lupus.

Usual Adult Dose of Plaquenil or Rheumatoid Arthritis:

Initial dosage: 400-600 mg of salt (310 or 465 mg base)/day taken orally, divided into one or two doses
Maintenance dosage: 200-400 mg sodium (155-300 mg base)/day taken orally in either 2 or 1 dose.
Maximum dosage Maximum dose: 600 mg of salt (465 mg base)/day or 6.5 mg/kg salt (5 mg/kg base)/day or the lower of the two, whichever is less.

Comments:
The action of this drug is cumulative and could take weeks or months of time to reach the highest therapeutic effects.
If a positive response is achieved, the initial dose can be decreased by 50% and then maintained at a lower dose.
Retinopathy is more likely to be diagnosed when this dose of maintenance exceeds 600 mg of salt (465 mg of base) or 6.5 mg/kg of sodium (5 mg/kg of base) or less; whichever is less is not recommended daily.
Corticosteroids and salicylates can be taken with this medication and can be reduced in dose gradually or removed after an appropriate maintenance dose of the drug has been reached.

Use: To treat chronic and acute rheumatoid arthritis

Usual Pediatric Dose of Plaquenil for Malaria Prophylaxis:

6.5 mg/kg sodium (5 mg/kg of base) every week, orally.
Maximum dose: 400 mg salt (310 mg base)/dose

Comments:
This medication should be given on the same day every week.
The treatment for immunosuppression should start 2 weeks before exposure and be maintained for 4 weeks after having left the area of endemicity.

Use: To prevent the spread of malaria in geographical zones where chloroquine resistance is not documented.

US CDC Recommendations: 5 mg/kg of base (6.5 mg/kg salt) daily, once or twice a week.
Maximum dose: 310 mg base (400 mg salt)/dose

Comments:
An alternative to chloroquine for prophylaxis only in areas with chloroquine-sensitive malaria
The practice should be initiated about 2 to 3 weeks prior to traveling to areas that are prone to violence and should be continued every week (same day every week) during the time you are in malarious zones and for the next 4 weeks after having left the area.
If malaria is detected while using this medication for chemoprophylaxis, it shouldn't be used in the treatment plan.
Current guidelines should be reviewed for further details.

Usual Pediatric Dose of Plaquenil for Malaria:

Initial dose of 13 mg/kg salt (10 mg/kg base) orally
The second dose (6 hours after the first dosage): 6.5 mg/kg salt (5 mg/kg base) orally
The third dose (24 hours after the first dosage): 6.5 mg/kg salt (5 mg/kg base) orally
4. (48 hours after the first dosage): 6.5 mg/kg salt (5 mg/kg base) orally

Maximum Dose:
First dose: 800 mg salt (620 mg base)/dose
Second, third, and fourth doses: 4 mg sodium (310 mg base)/dose

Comments:
A concurrent treatment with an 8-aminoquinoline drug is essential to achieving a complete cure for P viral and P ovale infections.

Use: To treat malaria that is not complicated due to P falciparum, malariae, P ovale, and P vivax.

US CDC Recommendations: 10 mg/kg of base taken orally at one time, and then 5 mg/kg of base orally at 6, 24, and 48 hours.
Total dose: 25 mg/kg base

Comments:
Pediatric doses should not exceed adult doses.
Recommend malaria that is not complicated (P falciparum or species that are not recognized) in areas with chloroquine susceptibility.
recommended for uncomplicated malaria (P malariae, P knowlesi, P vivax [unless chloroquine-resistant P vivax is suspected], or P ovale) in all regions; if treating P vivax or P ovale infections, concomitant treatment with primaquine (after quantitative testing to rule out G6PD deficiency) is recommended.
The current guidelines should be read for more details.

Do I be concerned if I miss a dose?

Contact your doctor for advice when you have missed the dose.

What will happen if I take excessively?

For medical emergencies, seek emergency treatment or contact the Poison Help Line at 1-800-222-1222. An overdose of hydroxychloroquine may be fatal and needs to be treated immediately.

The symptoms of an overdose can include drowsiness, vision changes, seizures, a slow heart rate, and a weak pulse. a beating heart beats that pound, sudden dizziness and weakening of the breath, shortness of breath, or a breath that is slow (breathing could be stopped).

Make sure this medication is out of reach of young children. An overdose of hydroxychloroquine could be fatal for the child who has ingested the medicine.

What should be avoided?

This medication can cause blurred vision and a decrease in your reaction. Avoid driving or engaging in hazardous activities until you are aware of the effects this medicine can have on you.

Beware of taking antacids as well as Kaopectate (Kaolin-pectin) for at least 4 hours prior to or 4 hours following the time you have taken Plaquenil.

Side effects of Plaquenil

Contact a medical professional immediately. If you are experiencing symptoms warnings of an allergy reaction to Plaquenil (hives and breathing difficulties or swelling of your throat or face) or a severe reaction to your skin (fever and throat soreness, burnt eyes, irritation, and the skin is red or purple and blisters and peels),

Seek medical attention in an emergency in the event that you are experiencing symptoms of a serious heart issue, including heartbeats that beat fast or rapidly, chest fluttering or breathlessness, and an abrupt dizziness (like it's possible to be stricken with a stroke).

Contact your doctor immediately in the event that you are suffering from:

• A seizure;
• Eyelids become yellow;
• Your ears are ringing and you are having difficulty hearing
• Strange mood change
• Severe muscle weakness, loss of coordination, inactive reflexes;
• Any sudden change in behavior, mood, or thoughts of suicide;
• Low blood cell count low blood cell counts, chills, fever, and fatigue, as well as mouth sores, easy bruising, abnormal bleeding, pale skin, cold feet and hands, and feeling lightheaded or weak;
• Lower blood sugar low blood sugar, anxiety, and sweating, irritability nausea, a fast heart rate, and feeling nervous or shakey;
• A serious drug reaction that can affect a variety of areas of your body, including the skin, rash and fever, swelling of glands, muscle aches, extreme weakness, unusual bruising, or the appearance of yellowing on your eyes or skin

Take care when taking Plaquenil long-term or in high doses; it can cause irreparable harm to the retinas of your eyes. Take a break from Plaquenil and consult your physician if you are suffering from:

• Blurred vision, difficulty focusing, trouble reading;
• Vision distortion, blind spots;
• Color vision changes;
• Blurry or cloudy vision
• Seeing light streaks or flashes and seeing halos around lights seeing light flashes or halos around lights
• Increased sensitiveness to the light.

Common side effects of Plaquenil include:

• Headache, dizziness;
• Nausea, vomiting, and stomach pain;
• Loss of appetite appetite loss, weight gain;
• Experiencing anxiety or feeling anxious;
• Itching, skin rash, or
• Hair loss.

This is not a comprehensive list of all side effects. Other side effects could occur. Consult your physician to seek medical advice on the effects. You can report any symptoms to the FDA at 1-800-FDA-1088.

Interaction with other drugs

Plaquenil could cause a serious heart issue. The risk is more likely if you take certain other medications for asthma, infections, heart conditions, high blood pressure, depression, mental illness, cancer, malaria, or HIV.

Discuss with your doctor your other medications, including:

• Cimetidine;
• Cyclosporine;
• Methotrexate;
• Rifampicin;
• Praziquantel;
• Ampicillin;
• Digoxin;
• Tamoxifen o
• Heart rhythm medicine;

This list isn't exhaustive. Other medications can interact with hydroxychloroquine. These include medications that are prescribed and available over the counter, vitamins, and herbal products. There are many possible interactions between drugs, which are included here.