Hydroxychloroquine

What is hydroxychloroquine?

What benefit can you expect from your treatment?

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.  

How is hydroxychloroquine taken?

It is taken by mouth in tablet form. 

When should it be taken? 

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. 

Can other medicines be taken with hydroxychloroquine? 

This medicine may be used alone or with other arthritis medicines including: 

• Other disease modifying antirheumatic drugs (DMARDs) such as methotrexate. 

• Steroid medicines such as prednisolone or cortisone injections into the joint. 

• Anti-inflammatory medicines (NSAIDs) such as naproxen (Naprosyn®) or 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. 

Are there any side effects?

Most common possible side effects 

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

What precautions are necessary?

Eye testing   

When you start treatment with hydroxychloroquine your doctor will discuss your vision and may ask you to have an eye test. 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 when 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. 

How to store hydroxychloroquine 

• 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.

IMPORTANT THINGS TO REMEMBER 

• 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.

For more information see the Hydroxychloroquine- information sheet

This Information Sheet has been prepared using materials obtained from various sources which have been reviewed by the Australian Rheumatology Association (ARA). It contains general information only and does not contain a complete or definitive statement of all possible uses, actions, precautions, side effects or interactions of the medicines referenced. This information is not intended as medical advice for individual conditions nor for making an individual assessment of the risks and benefits of taking a particular medicine. Decisions regarding the assessment and treatment of patients are the sole responsibility of the treating medical professional, exercising their own clinical judgment and taking into account all of the circumstances and the medical history of the individual patient.
ARA has used all reasonable endeavours to ensure the information on which this Information Sheet is based is accurate and up to date. However, the ARA accepts no responsibility or liability for the accuracy, currency, reliability and/or completeness of the information contained in this Information Sheet.  To the maximum extent permitted by law, the ARA expressly disclaims any liability for any injury, loss, harm or damage arising from or in connection with use of and reliance on the information contained in this Information Sheet.