NOT USED FOR COVID-19

Hydroxychloroquine, the active drug in Plaquenil, is not recommended for use in treating COVID-19 (the illness caused by caused by the coronavirus SARS-CoV-2). Do not take any prescription drug, including Plaquenil or hydroxychloroquine, unless your doctor recommends that you do so.

For information on how to prepare, advice on prevention and treatment, and expert recommendations, visit our COVID-19 hub.

Plaquenil is a brand-name prescription medication. It’s FDA-approved for the following uses:

  • Treating lupus. Lupus is an autoimmune disease that causes pain and swelling in your body. Specifically, Plaquenil is approved to treat chronic (long-lasting) discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE).
  • Treating rheumatoid arthritis (RA). RA is also an autoimmune disease. Plaquenil is approved to treat both acute RA (when RA symptoms, such as joint swelling, flare up) and chronic RA (when RA symptoms cause long-term effects, such as joint damage).
  • Preventing or treating malaria. Malaria is an infection that’s carried by mosquitos in tropical regions. If you get bitten by a mosquito that’s carrying malaria, you could become infected with this disease.

Note: For more information about the uses of Plaquenil, see the “Plaquenil Uses” section below.

To prevent or treat malaria, Plaquenil is approved for use in adults and children of all ages who weigh at least 31 kilograms (about 68 pounds). However, to treat lupus and RA, Plaquenil is only approved for use in adults.

Drug details

Plaquenil contains the active drug hydroxychloroquine. It belongs to a group of medications called antimalarial drugs.

Plaquenil comes as 200-milligram (mg) tablets that are taken by mouth.

Effectiveness

For information on the effectiveness of Plaquenil, see the “Plaquenil uses” section below.

Plaquenil’s limitations of use

The manufacturer has stated that when used to prevent or treat malaria, Plaquenil has certain limitations of use. For information on these limitations, see the “Plaquenil uses” section below.

Plaquenil contains the active drug hydroxychloroquine, which is available as a generic medication.

A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

In some cases, the brand-name drug and the generic version may come in different forms and strengths. However, both generic hydroxychloroquine and brand-name Plaquenil come as 200-mg tablets.

Plaquenil can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Plaquenil. These lists don’t include all possible side effects.

For more information on the possible side effects of Plaquenil, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you’d like to report to the FDA a side effect you’ve had with Plaquenil, you can do so through MedWatch.

Mild side effects

Mild side effects of Plaquenil can include:*

  • nausea, vomiting, or diarrhea
  • belly pain
  • fatigue (lack of energy)
  • headache
  • dizziness
  • feeling nervous or irritable
  • hair loss
  • weight loss

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Plaquenil. To learn about other mild side effects, talk with your doctor or pharmacist, or visit Plaquenil’s prescribing information.

Serious side effects

Serious side effects from Plaquenil aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

* These serious side effects are explained in more detail below in “Side effect details.”

Side effects in children

In clinical trials, side effects of Plaquenil in children weren’t reported separately from side effects in adults. So it’s not known if certain side effects of Plaquenil may occur more or less often in children compared with adults.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on certain side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Plaquenil. But it’s not known how many people taking Plaquenil have had an allergic reaction to the drug.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have a severe allergic reaction to Plaquenil. But call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Toxicity

Plaquenil may cause toxicity in different areas of your body, such as your eyes or skin. With toxicity, certain areas of your body may be damaged by the medication. Below, we describe certain toxicities caused by Plaquenil.

Retinal toxicity

Plaquenil may cause retinal toxicity, which is a severe side effect that can affect your vision. With retinal toxicity, damage occurs in your retina (thin layer of tissue inside your eye). In some cases, damage to your retina may be permanent.

Because of this risk, you should have an eye exam within 1 year of starting Plaquenil. Then, depending on your risk factors, your doctor may recommend that you have additional eye exams. Your doctor might suggest eye exams once every year or once every 5 years while you’re taking Plaquenil.

You have a higher risk of developing retina damage if you:

  • take high doses of Plaquenil
  • take Plaquenil for more than 5 years
  • have certain other health conditions or are taking certain other drugs

It’s not known how many people have had retinal toxicity while taking Plaquenil.

Before starting Plaquenil, be sure to talk with your doctor about other health conditions you have and any other medications you take. Your doctor will help determine if you have a high risk of retinal toxicity with Plaquenil.

If you develop retinal toxicity while you’re taking Plaquenil, your doctor will recommend that you stop taking the drug. Your doctor will also monitor your vision and your retina for any damage. It’s possible that retinal toxicity may worsen, even after stopping Plaquenil. If you have any changes in your vision while taking or after stopping Plaquenil, talk with your doctor right away.

Skin toxicity

It’s possible to have serious skin toxicities while you’re taking Plaquenil. Examples of very serious skin reactions that may be caused by Plaquenil include:

SJS and TEN are rashes that cause blistering and peeling of your skin. In some cases, these conditions can become life threatening. DRESS is also a serious skin rash. But with DRESS, you’ll typically have problems with other organs as well, such as your kidneys, liver, or lungs.

It’s not known how many people have had skin toxicities while taking Plaquenil.

Skin toxicities caused by Plaquenil can be very serious. So it’s important that you talk with your doctor right away if you notice any skin changes while you’re taking this drug. These changes may include itching, rash, hives, or blisters. Your doctor will determine how serious your skin condition is, and they’ll recommend the best way to manage it.

Rash and other skin reactions

You may develop a rash or other skin reaction while you’re taking Plaquenil. In some cases, skin reactions may be very serious and considered skin toxicities. See the “Skin toxicity” section above for more information about this.

It’s not known how many people have had skin rashes or skin toxicities while taking Plaquenil.

Keep in mind that Plaquenil may make your skin more sensitive to the sun. This means that while taking the drug, you may get a sunburn more easily than usual. So using sunscreen and wearing protective clothing while you are taking Plaquenil is very important to prevent sunburn.

In addition, Plaquenil may cause your skin to become scaly and red. The drug can also cause small blisters on your skin. These conditions aren’t usually severe or life threatening. However, in some cases, Plaquenil may cause very serious skin conditions. Because of this, it’s important to let your doctor know about skin changes you have while taking this drug.

If you have any skin changes while you’re taking Plaquenil, talk with your doctor right away. They’ll determine if your skin condition is serious, and they’ll recommend how to best manage it.

Weight gain or weight loss

For some people, Plaquenil may cause weight loss. This is because the drug can decrease your appetite, which may lead to the weight loss. But it’s not known how many people have had weight loss while taking Plaquenil.

Weight gain, on the other hand, isn’t a known side effect of Plaquenil.

If you have changes in body weight while you’re taking Plaquenil, talk with your doctor. They can recommend ways to help you manage a body weight that’s healthy for you.

Eye side effects

You may develop certain eye side effects and changes in your vision while you’re taking Plaquenil. For example, some people taking Plaquenil have reported blind spots. (With blind spots, you’re unable to see out of a certain area of your eye.)

In addition, Plaquenil may also cause blurry vision, double vision, or changes in your ability to see colors.

This drug can also cause changes in your cornea, such as swelling. (Your cornea is the clear lens on the front of your eye that controls the amount of light coming into your eye.) It’s possible that Plaquenil can build up in your cornea. And this buildup may cause blurry vision, halos around lights, and sensitivity to light.

Additionally, Plaquenil may cause a more serious condition called toxicity in your eyes. See the “Retinal toxicity” section above for more information about retinal toxicity.

It’s not known how many people have had eye side effects while taking Plaquenil.

If you have any changes in your vision while you’re taking Plaquenil, talk with your doctor right away. They’ll likely perform an eye exam to see if your vision has changed since you started taking Plaquenil. In some cases, your doctor may have you stop taking the drug if you develop eye side effects during treatment.

Problems with sleep

Plaquenil may cause certain problems with sleep, such as nightmares. And with nightmares, you may be unable to sleep well, leading to fatigue. (With fatigue, you have a lack of energy and feel tired.)

It’s not known how many people have had sleep problems while taking Plaquenil.

If you have trouble sleeping or develop fatigue while you’re taking Plaquenil, talk with your doctor. They may be able to recommend ways to help you sleep better and improve your energy level.

Hair loss

It’s possible to have hair loss while you’re taking Plaquenil. In addition to hair loss, some people taking the drug have reported changes in hair color.

It’s not known how many people have had hair loss or changes in hair color while taking Plaquenil.

If you notice changes in your hair while you’re taking Plaquenil, talk with your doctor. They may recommend a medication for you other than Plaquenil. They may also recommend ways to decrease these side effects from this drug.

It’s important to note that hair loss can also be a symptom of lupus, which Plaquenil is used to treat. If you have lupus and you’re experiencing hair loss with Plaquenil, your doctor can help determine whether it’s a side effect of the drug or a symptom of your condition.

Suicidal thoughts or behaviors

In rare cases, suicidal thoughts or behaviors may occur in people taking Plaquenil. But it’s not known for sure how many people have had these side effects while taking the drug.

If you’ve had suicidal thoughts or behaviors in the past, be sure to tell your doctor before you start taking Plaquenil. Your doctor may monitor you more often than usual to be sure that you’re doing well during this treatment.

If you have any suicidal thoughts or behaviors while you’re taking Plaquenil, see your doctor right away. But if your symptoms are life threatening, call 911 or your local emergency number.

In some cases, your doctor may have you stop taking Plaquenil. If that happens, they’ll recommend a medication for your condition other than Plaquenil.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

  • Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
  • Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
  • Not in the United States? Find a helpline in your country with Befrienders Worldwide.
  • Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you’re not in the same household, stay on the phone with them until help arrives.

The Food and Drug Administration (FDA) approves prescription drugs such as Plaquenil to treat certain conditions. Plaquenil may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Plaquenil is approved for the following uses, which are described below in more detail:

Plaquenil for lupus

Plaquenil is approved to treat certain forms of lupus in adults. With lupus, which is an autoimmune disease, your immune system attacks your own body. This leads to pain and swelling in your body. In particular, lupus can affect your skin, joints, and organs such as your kidneys and heart.

It’s not known for sure what causes lupus. However, the condition may be related to your genetics, hormones, or environment.

Specifically, Plaquenil is approved to treat these two forms of lupus:

DLE primarily affects your skin. With this condition, you may develop sores, swelling, or thick scarring on your skin. SLE, on the other hand, can cause different types of symptoms. These include muscle and joint pain, rash, and fatigue (lack of energy).

Effectiveness for lupus

The manufacturer of Plaquenil didn’t report the drug’s effectiveness in treating lupus. This is because Plaquenil was approved in 1955, and at that time, clinical studies for effectiveness weren’t done.

However, one review looked at 95 articles about antimalarial drugs being used to treat lupus. (Plaquenil belongs to a group of drugs called antimalarials.) This review showed that these drugs, including Plaquenil, prevent symptoms of lupus from flaring up. According to the review, the drugs also increase survival length in people with lupus.

Because Plaquenil has been used effectively for lupus over many years, it’s recommended as a key treatment for lupus by the American Academy of Family Physicians. Plaquenil is recommended for treating lupus because it decreases symptom flare-ups and slows the condition from worsening.

Plaquenil for rheumatoid arthritis

Plaquenil is approved to treat RA in adults. With RA, which is an autoimmune disease, your immune system attacks your joints. This causes aching, pain, stiffness, and swelling in your joints. Most often, hands, wrists, and knees are affected by RA.

It’s not known for sure what causes RA. But the condition may be related to your genetics or environmental exposures.

Specifically, Plaquenil is approved to treat both:

  • acute RA (when RA symptoms, such as joint swelling, flare up)
  • chronic RA (when RA symptoms cause long-term effects, such as joint damage)

In some cases, Plaquenil may be used along with other drugs to treat RA.

Effectiveness for rheumatoid arthritis

The manufacturer of Plaquenil didn’t report the drug’s effectiveness in treating RA. This is because Plaquenil was approved in 1955, and at that time, clinical studies for effectiveness weren’t done.

However, one trial looked at people with RA who took Plaquenil. The trial showed that after 36 weeks of taking the drug, people had decreased joint pain and increased joint function.

In addition, the American College of Rheumatology recommends Plaquenil, and other disease-modifying antirheumatic drugs (DMARDs), for treating RA. (DMARDs are a group of medications used to treat RA.) In some cases of RA treatment, DMARDs may be used along with other medications.

Plaquenil for malaria

Plaquenil is approved to both treat and prevent malaria. It can be used for this condition in both adults and children who weight at least 31 kilograms (about 68 pounds).

When used to prevent malaria, Plaquenil is taken before you travel to an area where you’re at risk of getting malaria.

Malaria is a disease that’s carried by mosquitos in tropical regions. If you get bit by a mosquito that’s carrying parasites that cause malaria, you may develop the disease. Symptoms of malaria include fever, chills, headache, nausea, and vomiting.

Plaquenil’s limitations of use for malaria

The manufacturer has stated that when used to prevent or treat malaria, Plaquenil has the following limitations of use:

  • It’s not meant to be used for complicated cases of malaria. Plaquenil should only be used for people with uncomplicated malaria infections. (Malaria is considered complicated if you have severe symptoms such as kidney problems, trouble breathing, or coma.)
  • It’s not effective for strains of malaria that don’t improve with either chloroquine or hydroxychloroquine. (Hydroxychloroquine is the active drug in Plaquenil.) Plaquenil shouldn’t be used to treat or prevent malaria that was contracted in areas of the world where the disease doesn’t improve with chloroquine.
  • It shouldn’t be used for malaria contracted in areas of the world where Plasmodium species of malaria haven’t been found. (Species describe certain groups of living things that are closely related.)
  • It shouldn’t be used to prevent relapses of malaria caused by the parasites P. vivax or P. ovale. This is because Plaquenil isn’t effective against these types of infections. If Plaquenil is used for these infections, a treatment that contains 8-aminoquinoline must be used with Plaquenil.

Effectiveness for malaria

The manufacturer of Plaquenil didn’t report the drug’s effectiveness in people with malaria. This is because Plaquenil was approved in 1955, and at that time, clinical studies for effectiveness weren’t done.

Malaria treatment guidelines from the Centers for Disease Control and Prevention (CDC) state that hydroxychloroquine can be used to treat certain types of malaria. (Hydroxychloroquine is the active drug in Plaquenil.)

Plaquenil is also recommended by the CDC to prevent malaria. However, Plaquenil should only be taken for malaria prevention in areas of the world where malaria isn’t resistant to the drug. (With resistance, the infection doesn’t respond to a certain treatment.)

So if you’re traveling to a region where malaria is resistant to Plaquenil, your doctor may recommend a medication other than Plaquenil for you.

Off-label use for Plaquenil

In addition to the uses listed above, Plaquenil may be used off-label for other purposes. Off-label drug use is when a drug that’s approved for one use is used for a different one that’s not approved.

Plaquenil for osteoarthritis

Plaquenil is approved to treat rheumatoid arthritis (RA), which is an autoimmune disease. (With autoimmune conditions, your immune system attacks your own body.) The drug isn’t approved to treat osteoarthritis, which isn’t an autoimmune disease. But sometimes Plaquenil is used off-label to treat osteoarthritis.

Osteoarthritis is the most common type of arthritis. It occurs with age as your joints become worn out. Specifically, osteoarthritis occurs when your cartilage (the tissue that cushions your joints) wears out. Osteoarthritis may cause pain, swelling, and joint stiffness. Usually, the condition affects joints in your hands, hips, or knees.

One trial looked at people with osteoarthritis in their knees who took Plaquenil. While taking the drug, people’s osteoarthritis symptoms were reduced.

However, another study looked at people with osteoarthritis in their hands who took Plaquenil. This study showed that Plaquenil didn’t help reduce osteoarthritis symptoms more than a placebo did. (A placebo is a treatment with no active drug).

If you’d like to know more about using Plaquenil for osteoarthritis, talk with your doctor.

Plaquenil for Sjogren’s syndrome

Plaquenil isn’t approved to treat Sjogren’s syndrome. But sometimes it’s used off-label for this condition.

Sjogren’s syndrome is an autoimmune disease, which means it’s caused when your immune system attacks your own body. People with Sjogren’s syndrome develop dry eyes and dry mouth. That’s because with this disease, the glands that make your saliva and tears are attacked by your immune system. Some people with Sjogren’s syndrome may also have joint pain, rash, or fatigue (lack of energy).

One study looked at people taking hydroxychloroquine along with leflunomide (Arava). (Hydroxychloroquine is the active drug in Plaquenil.) This treatment regimen was safe and effective at treating Sjogren’s syndrome in these people.

However, another study looked at four trials of people with Sjogren’s syndrome. In the trials, people had been given either Plaquenil or a placebo (treatment with no active drug). The study showed that there wasn’t any difference in dry mouth or dry eyes between the two groups of people.

If you have questions about treatment options for Sjogren’s syndrome, talk with your doctor.

Plaquenil and children

Plaquenil is approved to both treat and prevent malaria in children of all ages who weigh at least 31 kg (about 68 lb). For information about this condition and Plaquenil’s effectiveness for it, see the “Plaquenil for malaria” section above.

When the COVID-19 pandemic first began, Plaquenil was considered as a possible treatment option. But at this time, hydroxychloroquine (the active drug in Plaquenil) isn’t recommended as a treatment for COVID-19.

Initially, the Food and Drug Administration (FDA) allowed hydroxychloroquine to be used for medical emergencies due to COVID-19. Allowing the drug to be used for this purpose is called an Emergency Use Authorization (EUA).

With an EUA, a drug can be used in emergency situations for a condition that it’s not approved for. And with an EUA, the drug may be taken from the Strategic National Stockpile. This stockpile is a reserve of essential medications and other supplies for use during public health emergencies.

However, as information from clinical trials was released about using hydroxychloroquine for COVID-19, the FDA revoked the drug’s EUA. This happened because there seemed to be more risk than benefit in using the drug for this condition.

About COVID-19

COVID-19 is a respiratory disease that causes fever and cough. In some people, COVID-19 is mild. But in other people, the disease can be life threatening.

COVID-19 is caused by a new form of the coronavirus. But other types of coronaviruses can also cause respiratory illnesses. For more information about COVID-19 and the coronavirus, see our COVID-19 hub.

If you have questions about treatments for COVID-19, talk with your doctor.

The Plaquenil dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition for which you’re using Plaquenil
  • your age
  • your body weight
  • other medical conditions you may have
  • side effects from Plaquenil

Your doctor may adjust your dose over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug form

Plaquenil comes as tablets that are taken by mouth. Plaquenil should be taken with a meal or glass of milk. It shouldn’t be taken on an empty stomach.

Drug strength: 200 mg

Plaquenil tablets are available in one strength: 200 milligrams (mg).

Dosage for lupus

The typical Plaquenil daily dosage for lupus is 200 mg to 400 mg taken by mouth. This daily dosage may be taken as a single dose once daily or as divided doses twice daily.

So if you’re taking 400 mg of Plaquenil daily, you may either take 400 mg once daily or 200 mg twice daily. Your doctor will recommend the dosage schedule that’s best for you.

Maximum dosage of Plaquenil for lupus

Plaquenil dosages for lupus shouldn’t be more than 400 mg each day. At dosages higher than 400 mg daily, vision problems have occurred more often than when the drug is used at lower dosages. For more information about eye and vision side effects caused by Plaquenil, see the “Plaquenil side effects” section above.

Dosage for rheumatoid arthritis

For rheumatoid arthritis (RA), you’ll begin Plaquenil treatment by taking a starting dosage of the drug. (The starting dosage is higher than the dosage you’ll take on a long-term basis.) Once Plaquenil begins reducing your RA symptoms, your doctor will decrease your dosage.

The typical starting dosage of Plaquenil for RA is 400 mg to 600 mg daily. This total daily dosage may be taken as a single dose once daily or as divided doses twice daily.

So if you’re taking 400 mg of Plaquenil daily, you may take 400 mg as either a single dose once daily or 200 mg twice daily. If you develop side effects, your doctor may reduce your starting dosage of Plaquenil to help decrease the side effects.

After Plaquenil begins reducing your RA symptoms, your doctor may lower your dosage. Usually, the maintenance (long-term) dosage of Plaquenil for RA is 200 mg to 400 mg daily. And this total daily dosage may be taken as a single dose once daily or as divided doses twice daily.

Maximum dosage for rheumatoid arthritis

Plaquenil dosages for RA shouldn’t be more than 600 mg daily. In addition, you shouldn’t take a daily dosage of Plaquenil that’s higher than 5 mg of drug per kilogram (kg) of your body weight. (One kg is about equal to 2.2 pounds.) So if you weigh 140 lb, you shouldn’t take a daily dosage of Plaquenil that’s higher than 318 mg.

At Plaquenil dosages higher than 5 mg/kg daily, vision problems have occurred more often than when the drug was used at lower dosages. For more information about eye and vision side effects caused by Plaquenil, see the “Plaquenil side effects” section above.

Dosage for malaria

Typical dosages of Plaquenil for malaria in adults vary depending on whether you’re using the drug to treat or prevent this infection. Below, we describe typical Plaquenil dosages for adults for each of these situations.

For information on dosages of Plaquenil for malaria in children, see the “Pediatric dosage” section below.

Dosage for malaria prevention

The typical Plaquenil dosage for preventing malaria* in adults is 400 mg taken once weekly.

You should take your weekly Plaquenil dose on the same day each week. For example, if you take your first dose on a Sunday, keep taking Plaquenil on Sunday each week.

For malaria prevention, you should start taking Plaquenil 2 weeks before you’re going to be in an area where you’ll be at risk for malaria. And you should continue taking Plaquenil while you’re in that area. After you leave the area, you’ll continue taking Plaquenil for 4 weeks.

* Plaquenil is used in certain situations for malaria prevention. To learn about these specific uses, see the “Plaquenil uses” section below.

Dosage for malaria treatment

The typical Plaquenil dosage for treating malaria* in adults is four doses of Plaquenil taken over the course of 48 hours. Your first dose of the drug will be 800 mg. Then 6 hours after your first dose, you’ll take 400 mg of Plaquenil. After that, you’ll take 400 mg of Plaquenil 24 hours after your first dose. And you’ll take your last dose of 400 mg of Plaquenil 48 hours after your first dose.

* Plaquenil is used in certain situations for malaria treatment. To learn about these specific uses, see the “Plaquenil uses” section below.

Pediatric dosage

Plaquenil is approved to both treat and prevent malaria in children. Typical dosages of Plaquenil for malaria in children are based on body weight. Below, we describe typical Plaquenil dosages for each of these uses in children.

Because you can’t break or cut Plaquenil tablets, the drug shouldn’t be used in children who weigh less than 31 kg (about 68 lb). This is because their required dose would be lower than 200 mg, which is the lowest strength available in Plaquenil tablets.

Note: While Plaquenil is approved to treat lupus and rheumatoid arthritis (RA) in adults, the drug isn’t approved for these uses in children.

Pediatric dosage for malaria prevention

To prevent malaria in children, the typical dosage of Plaquenil is 6.5 mg of drug per kg of body weight taken once weekly.

So if your child weighs 77 lb (about 35 kg), their Plaquenil dosage would be about 200 mg each week.

In any case, Plaquenil dosages in children to prevent malaria shouldn’t be more than 400 mg each week.

Pediatric dosage for malaria treatment

To treat malaria in children, four doses of Plaquenil are taken over the course of 48 hours.

For their first dose of Plaquenil, children will take 13 mg of drug per kg of body weight. Six hours after the first dose, they’ll take 6.5 mg/kg of Plaquenil. Then 24 hours after their first dose, they’ll take another dose of 6.5 mg/kg. And finally, 48 hours after their first dose, they’ll take their final dose of 6.5 mg/kg.

So if your child weighs 77 pounds (about 35 kg), their first dose of Plaquenil will be about 400 mg. Then 6 hours later, they’ll take 200 mg. And their last two doses of Plaquenil, taken 24 hours and 48 hours after their first dose, will both be 200 mg.

In any case, the first dose of Plaquenil in children to treat malaria shouldn’t be more than 800 mg. And the doses that follow shouldn’t be more than 400 mg each.

What if I miss a dose?

If you miss a dose of Plaquenil, talk with your doctor or pharmacist. They’ll recommend when you should take your next dose of treatment. But this will depend on why you’re taking Plaquenil.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. A kitchen timer may be useful, too.

Will I need to use this drug long term?

It depends on why you’re taking Plaquenil. For example:

  • If you’re taking Plaquenil to treat either lupus or RA, you’ll likely take it as a long-term treatment (that is, if you and your doctor determine that Plaquenil is safe and effective for you).
  • If you’re taking Plaquenil to prevent malaria, you’ll start taking it 2 weeks before you’ll be in an area where you’re at risk for malaria. You’ll continue taking Plaquenil while you’re in that area and for 4 weeks after you’ve left the area. Typically, once you’ve been out of the area for 4 weeks, you can stop taking Plaquenil.
  • If you’re taking Plaquenil to treat malaria, you’ll take four doses of the drug over the course of 48 hours. Generally, after 48 hours of treatment, you’ll stop taking Plaquenil.

If you have questions about the length of Plaquenil treatment that’s right for you, talk with your doctor.

Here are answers to some frequently asked questions about Plaquenil.

Is Plaquenil an immunosuppressant or a steroid?

No, Plaquenil isn’t an immunosuppressant drug. (Immunosuppressants work by lowering the activity of your immune system.) It’s not a steroid either.

Instead, Plaquenil is called an antimalarial drug because it’s used to prevent or treat malaria. Plaquenil is also used to treat rheumatoid arthritis (RA) and certain forms of lupus.

When Plaquenil is used to treat RA and lupus, it’s considered a disease-modifying antirheumatic drug (DMARD). DMARDs help manage symptoms of autoimmune diseases, such as RA and lupus.

Certain immunosuppressants are also used to treat lupus and RA. Examples of immunosuppressant drugs include steroids, such as prednisone.

It’s not known exactly how Plaquenil works for its approved uses. The drug may alter the way your immune system works. However, Plaquenil shouldn’t weaken the activity of your immune system.

Will Plaquenil cure my condition?

That depends on why you’re taking Plaquenil. For example:

  • If you’re taking Plaquenil to treat lupus or RA, Plaquenil can decrease symptoms of either condition. But Plaquenil won’t cure these conditions. In fact, at this time, there’s no known cure for lupus or RA.
  • If you’re taking Plaquenil to prevent malaria, the drug will work by stopping your body from becoming infected with the disease. So rather than cure malaria, Plaquenil can stop the disease from infecting you.
  • If you’re taking Plaquenil to treat malaria, the drug will likely cure the condition if you complete the four recommended doses.

If you have questions about what you can expect with Plaquenil treatment, talk with your doctor.

Is Plaquenil still available during the COVID-19 pandemic?

Yes, you should still be able to get Plaquenil during the COVID-19 pandemic, if your doctor prescribes it for you.

When the COVID-19 pandemic first began, Plaquenil was considered as a possible treatment option. For more information about this, see the “Plaquenil for COVID-19 (coronavirus)” section above.

Because of use, the amount of Plaquenil available on the market was limited. However, at this time, using Plaquenil to treat COVID-19 is controversial. The drug hasn’t been effective enough in treating COVID-19 to be accepted as a mainstream treatment recommendation.

In some states, rules have been established to ensure that Plaquenil isn’t stockpiled or prescribed for inappropriate reasons. For example, some states require that Plaquenil only be prescribed for its approved uses, which does not include COVID-19. (For information on the approved uses of Plaquenil, see the “Plaquenil uses” section above.) And other states have been limiting the amount of Plaquenil you can get at one time.

If you have concerns about being able to get Plaquenil, talk with your doctor or pharmacist. If your usual pharmacy doesn’t have any Plaquenil on hand, your pharmacist may be able to find a pharmacy that has the medication in stock.

Will Plaquenil lower my blood sugar level?

Yes, Plaquenil may decrease your blood sugar level, which can be very serious. In some cases, low blood sugar may be deadly if it’s not treated.

Symptoms of low blood sugar include sweating, feeling confused or dizzy, and having a fast heart rate.

If you develop low blood sugar, the American Diabetes Association (ADA) recommends following the “15-15 rule”: Ingest 15 grams of carbohydrates, wait 15 minutes, and then recheck your blood sugar level.

Examples of foods with 15 grams of carbohydrates in them include:

  • 4 ounces of non-diet soda
  • 1 tablespoon of sugar, honey, or corn syrup

In addition, the following items may be used to increase your blood sugar level. Just be sure to check the label of each to make sure you’re getting 15 grams of carbohydrates in your serving size. These items include:

  • sugary candies
  • glucose tablets
  • glucose gel

If you develop low blood sugar while you’re taking Plaquenil, your doctor may order lab tests to monitor your blood sugar levels. Your doctor may also have you check your blood sugar levels at home on a regular basis. This will help ensure that your blood sugar level doesn’t become too low.

Is it safe to go out in the sun while taking Plaquenil?

Yes, probably. You shouldn’t have to avoid sunlight while you’re taking Plaquenil. However, Plaquenil can cause your skin to burn more quickly and more easily than usual.

So if you’re planning to be in the sun while you’re taking Plaquenil, it’s important to take certain safety precautions. These include:

  • using sunscreen on exposed areas of your body
  • wearing a hat, long sleeves, or pants to protect your skin from burning

If you have concerns about sunburn while you’re taking Plaquenil, talk with your doctor.

Is Plaquenil safe for older people to take?

That’s not known for sure. Clinical trials of Plaquenil didn’t include very many people over the age of 65 years.

Keep in mind that Plaquenil is removed from the body through your kidneys. Because older adults may have decreased kidney function, the drug may build up in their body. And this could increase their risk of side effects from Plaquenil.

So if you’re older and planning to take Plaquenil, your doctor may order blood tests to check your kidney function. If your kidney function is decreased, your doctor may prescribe for you a dosage of Plaquenil that’s lower than usual. Or during treatment, your doctor may monitor your kidney function more often than usual.

If you have questions about using Plaquenil given your age, talk with your doctor. They can recommend a treatment plan that’s right for you.

What side effects could I have when stopping Plaquenil?

You shouldn’t have withdrawal symptoms or other side effects when stopping Plaquenil.

However, if you’re taking Plaquenil for lupus or rheumatoid arthritis (RA), you may notice that your condition gets worse when you stop taking the drug. That’s because Plaquenil treats these conditions by reducing their symptoms. So when you stop taking Plaquenil, your symptoms may worsen.

On the other hand, if you’re taking Plaquenil to prevent or treat malaria, you shouldn’t notice any changes after you’ve completed treatment (that is, unless you had symptoms of malaria before starting Plaquenil). In that case, your symptoms should be gone after treatment is completed.

Before stopping Plaquenil, talk with your doctor. They’ll recommend the safest way for you to stop treatment. And they can advise what you can expect after stopping the drug.

Does Plaquenil treat fibromyalgia?

Plaquenil isn’t approved to treat fibromyalgia, and it hasn’t been studied for this purpose. Fibromyalgia causes generalized pain in your body.

People who have rheumatoid arthritis (RA) or lupus have a higher risk of developing fibromyalgia. And Plaquenil is approved to treat RA and certain forms of lupus.

So, Plaquenil may be used by people who have fibromyalgia along with these conditions. But it isn’t known for sure if Plaquenil is effective for treating fibromyalgia.

If you’d like to know about treatment options for fibromyalgia, talk with your doctor.

Plaquenil comes as tablets that are taken by mouth. You should take this drug according to your doctor or another healthcare professional’s instructions.

When to take

Plaquenil should be taken as directed by your doctor. How often and for how long you’ll take the drug will vary depending on the condition for which it’s being used. For example:

  • To treat lupus or rheumatoid arthritis (RA), Plaquenil is typically taken once or twice each day. And the drug is continued for as long as your doctor recommends. You’ll want to be sure to take your doses of Plaquenil at about the same time each day.
  • To prevent malaria, you’ll likely take a dose of Plaquenil once every week. You’ll likely start taking the drug 2 weeks before you’re going to be in an area where you’ll be at risk for malaria. And you’ll continue taking these weekly doses for 4 weeks after you leave the area where you were at risk for malaria. You’ll want to be sure to take your doses of Plaquenil on the same day each week.
  • To treat malaria, you’ll take four doses of Plaquenil over a 48-hour time period. You’ll take your first dose, followed by three other doses taken 6 hours, 24 hours, and 48 hours after the first dose.

And to help make sure that you don’t miss a dose, try setting a reminder on your phone. A kitchen timer may be useful, too.

Best time to take Plaquenil

The manufacturer of this drug hasn’t stated a time of day that’s best to take it. If you have questions about when to take doses of Plaquenil, talk with your doctor or pharmacist.

Taking Plaquenil with food

You should take your doses of Plaquenil with a meal or a glass of milk. This drug shouldn’t be taken on an empty stomach.

Can Plaquenil be crushed, split, or chewed?

No, you shouldn’t crush, split, or chew Plaquenil tablets. Instead, the tablets should be swallowed whole.

Plaquenil contains the active drug hydroxychloroquine. It’s approved for the following uses:

  • Treating lupus. Lupus is an autoimmune disease that causes pain and swelling in your body. Specifically, Plaquenil is approved to treat chronic (long-lasting) discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE).
  • Treating rheumatoid arthritis (RA). RA is also an autoimmune disease. Plaquenil is approved to treat both acute RA (when RA symptoms, such as joint swelling, flare up), and chronic RA (when RA symptoms cause long-term effects, such as joint damage).
  • Preventing or treating malaria. Malaria is an infection that’s carried by mosquitos in tropical regions. If you get bitten by a mosquito that’s carrying malaria, you can become infected with this disease.

Note: For more information about the uses of Plaquenil, see the “Plaquenil Uses” section above.

What Plaquenil does in your body

It’s not known for sure how Plaquenil works for its approved uses. But it’s thought that:

  • In people with lupus, Plaquenil may decrease the number of autoantibodies they have. (Autoantibodies are immune system proteins that attack a person’s own body.) By doing this, the drug can decrease symptoms of lupus.
  • Much like lupus, people with RA also have too many autoantibodies. Plaquenil may work in the same way to treat RA and as it does lupus. By doing this, the drug can decrease symptoms of RA.
  • In people with malaria, Plaquenil may work by blocking the acid in malaria parasites. This doesn’t allow your body to be infected with the disease.

How long does it take for Plaquenil to work?

Plaquenil may take some time to begin working in your body. And how quickly it works will depend on the reason why you’re taking the drug. For example:

  • If you’re taking Plaquenil long term to treat lupus or RA, you may not notice a change in your symptoms for weeks to months after starting the drug. But even if you don’t notice a change in your symptoms right away, you should continue taking Plaquenil as directed by your doctor.
  • If you’re taking Plaquenil to prevent malaria, you should start taking the drug 2 weeks before you travel to an area where you have an increased risk of the disease. This gives the drug time to start working so that you’ll be protected from malaria when you do travel.
  • If you’re taking Plaquenil to treat malaria, you’ll only need to take four doses of the drug over the course of 48 hours. In this case, Plaquenil should start working to fight off the infection right after your first dose.

If you have questions about what to expect with Plaquenil treatment given your condition, talk with your doctor.

How long does Plaquenil stay in your system?

Plaquenil has a half-life of about 40 days. This means that it takes about 40 days for your body to clear half a dose of the drug after you take it.

Generally, a drug is fully cleared from your system after about five half-lives. For Plaquenil, this means that the drug is fully cleared from your system about 200 days after your last dose.

As with all medications, the cost of Plaquenil can vary.

The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Plaquenil, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Plaquenil, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Plaquenil, or if you need help understanding your insurance coverage, help may be available.

For information on possible cost assistance for Plaquenil, visit MedicineAssistanceTool.org. Or talk with your doctor or pharmacist to learn about ways to help lower the cost of this drug.

Generic version

Plaquenil is available as a generic medication called hydroxychloroquine. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. And generics tend to cost less than brand-name drugs.

If your doctor has prescribed Plaquenil and you’re interested in using hydroxychloroquine instead, talk with your doctor. They may have a preference for one version or the other. You’ll also need to check your insurance plan, as it may only cover one or the other.

Plaquenil may increase your level of liver enzymes. And this could indicate there’s been some damage to your liver by the drug. In some cases, Plaquenil may also cause liver failure.

Because alcohol also effects your liver, drinking alcohol while you’re taking Plaquenil may increase your risk of liver problems.

If you drink alcohol, talk with your doctor. They can recommend whether there’s a safe amount of alcohol you can drink while you’re taking Plaquenil.

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Plaquenil, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Alternatives for lupus

Examples of other drugs that may be used to treat lupus include:

Alternatives for rheumatoid arthritis

Examples of other drugs that may be used to treat rheumatoid arthritis (RA) include:

Alternatives for malaria

Examples of other drugs that may be used to treat malaria include:

  • atovaquone/proguanil (Malarone)
  • chloroquine
  • mefloquine
  • artemether/lumefantrine (Coartem)

Examples of other drugs that may be used to prevent malaria include:

  • atovaquone/proguanil (Malarone)
  • chloroquine
  • doxycycline (Vibramycin)
  • mefloquine
  • tafenoquine (Arakoda)

It isn’t known whether Plaquenil is safe to take during pregnancy. There haven’t been increased fetal development problems in human pregnancies exposed to the drug.

However, animal studies show there may be an increased risk of fetal problems and fetal death in animals exposed to Plaquenil during pregnancy. But keep in mind that animal studies don’t always predict what will happen in humans.

If you do take Plaquenil during pregnancy, consider participating in a pregnancy registry for the drug. Pregnancy registries help researchers understand the safety of a drug during pregnancy. To learn more, talk with your doctor. You can also call 877-311-8972.

If you’re pregnant or planning to become pregnant, talk with your doctor before taking Plaquenil. They can recommend whether it’s safe for you to take this drug.

It’s not known if Plaquenil is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Plaquenil.

For more information about taking Plaquenil during pregnancy, see the “Plaquenil and pregnancy” section above.

Plaquenil does pass into human breast milk, which means it can be passed to a child who’s breastfed. Because small amounts of Plaquenil can be toxic to a young child, you should talk with your doctor before breastfeeding while using this drug.

In some cases, your doctor may recommend a medication other than Plaquenil for you to take while you’re breastfeeding.

Plaquenil can interact with several other medications. But Plaquenil isn’t known to interact with supplements or foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Plaquenil and other medications

Below we discuss some of the medications that can interact with Plaquenil. These aren’t all the drugs that may interact with Plaquenil.

Before taking Plaquenil, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Plaquenil and digoxin

Taking Plaquenil along with the heart medication digoxin (Lanoxin) may increase the level of digoxin in your body. Having too much digoxin in your body can cause serious side effects. These include nausea, vomiting, a slow or fast heart rate, or changes in your heart rhythm.

If you’re taking Plaquenil along with digoxin, your doctor will monitor your digoxin levels. This allows your doctor to be sure that the levels aren’t too high.

Plaquenil and diabetes medications

Plaquenil may cause your blood sugar level to become too low. Taking Plaquenil along with diabetes drugs, including insulin, increases the risk of your blood sugar becoming too low. This condition, called hypoglycemia, can be very dangerous. Symptoms of hypoglycemia include sweating, feeling confused or dizzy, and having a fast heart rate.

Examples of diabetes medications that may cause hypoglycemia include:

Even if you aren’t taking diabetes medications, your doctor will monitor your blood sugar while you’re taking Plaquenil.

If you are taking diabetes drug with Plaquenil, your doctor may decrease the dosage of your other diabetes drugs. This helps to ensure that your blood sugar level doesn’t get too low during treatment.

Plaquenil and drugs that affect your heart rhythm

Plaquenil can affect your heart rhythm by lengthening part of the heart rhythm, called the QT interval. If you’re taking more than one drug that affects your heart rhythm, you may have an increased risk of serious heart rate or heart rhythm problems.

Examples of drugs that may affect your heart rhythm include:

Before you start taking Plaquenil, talk with your doctor about all the medications you’re taking. Your doctor can determine if it’s safe for you to take Plaquenil.

Plaquenil and medications that increase your risk of seizures

Plaquenil may increase your risk of seizures. If you take Plaquenil along with other drugs that also increase the risk of seizures, you have an even higher seizure risk.

Examples of medications that may increase your risk of seizures include:

Before you start taking Plaquenil, talk with your doctor about all the medications you’re taking. Your doctor can determine if it’s safe for you to take Plaquenil.

Plaquenil and antiepileptic medications

Antiepileptic drugs are used to treat seizure disorders. Taking Plaquenil along with antiepileptic drugs could make your antiepileptic drug less effective. This may increase your risk of seizures.

Examples of antiepileptic medications include:

If you are taking any antiepileptic drugs, talk with your doctor before starting Plaquenil. They may recommend a seizure drug that doesn’t interact with Plaquenil.

Plaquenil and methotrexate

Studies have shown that using hydroxychloroquine (the active drug in Plaquenil) and methotrexate (Trexall) together is effective for treating rheumatoid arthritis (RA).

However, it’s not known if Plaquenil and methotrexate interact with each other. This is because the two drugs haven’t been studied for drug interactions. But taking Plaquenil and methotrexate together may increase your risk of side effects from both medications.

Before taking Plaquenil with methotrexate, talk with your doctor. They can recommend a treatment plan that’s right for you.

Plaquenil and cyclosporine

Studies have shown that hydroxychloroquine (the active drug in Plaquenil) and cyclosporine (Neoral) are an effective combination for treating refractory rheumatoid arthritis (RA). (Refractory RA is RA that didn’t improve enough with other therapies.)

However, taking Plaquenil along with cyclosporine may increase the level of cyclosporine in your body. And this may increase your risk of side effects from cyclosporine.

If you’re taking cyclosporine, be sure to talk with your doctor before starting Plaquenil. They may monitor you during treatment to be sure that your levels of cyclosporine aren’t too high.

Plaquenil and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Plaquenil. However, you should still check with your doctor or pharmacist before using any of these products while taking Plaquenil.

Plaquenil and foods

There aren’t any foods that have been specifically reported to interact with Plaquenil. If you have any questions about eating certain foods with Plaquenil, talk with your doctor.

Before taking Plaquenil, talk with your doctor about your health history. Plaquenil may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Blood disorders, such as anemia. Plaquenil may cause decreased levels of red blood cells, white blood cells, or platelets (the cells in your blood that help the blood to clot). If you already have a blood disorder, such as anemia (low red blood cell level), taking Plaquenil may worsen your condition. If you have any blood disorders, talk with your doctor before taking Plaquenil. They may monitor your blood cell levels more often than usual during treatment. Or they may recommend a medication other than Plaquenil for you.
  • Gastrointestinal conditions, such as ulcerative colitis. Plaquenil may cause nausea, vomiting, diarrhea, and belly pain. If you have a gastrointestinal (GI) condition, such as ulcerative colitis (UC), Plaquenil may worsen symptoms of your condition. Before taking Plaquenil, talk with your doctor about any GI conditions you have. During treatment, your doctor may monitor you more often than usual for GI-related side effects.
  • Neurological conditions, such as seizures. Plaquenil may cause seizures or other conditions that affect your brain and nervous system, such as tremors or having trouble with movements. If you have a brain or nervous system condition, such as epilepsy, Plaquenil may worsen symptoms of your condition. Talk with your doctor about any history of brain or nervous system conditions before you start taking Plaquenil.
  • History of suicidal thoughts or behaviors. If you’ve had any suicidal thoughts or behaviors in the past, talk with your doctor starting Plaquenil. This drug may cause suicidal thoughts or behaviors. So taking Plaquenil could worsen your suicidal thoughts or behaviors. Your doctor may monitor you more often during treatment. Or they may recommend a medication other than Plaquenil to treat your condition.
  • Liver disease, such as hepatitis. Plaquenil may increase your liver enzyme levels, which could indicate liver damage. The drug may also cause liver problems, such as liver failure. If you already have a history of liver problems, taking Plaquenil could worsen your condition. Before starting Plaquenil, be sure to discuss any liver problems with your doctor. They may monitor certain blood tests more often than usual during treatment. Or they may recommend a medication other than Plaquenil to treat your condition.
  • Alcohol misuse. Both alcohol and Plaquenil can damage your liver. People who misuse alcohol may need to take a medication other than Plaquenil. If you drink alcohol, be sure to talk with your doctor before you start taking Plaquenil.
  • Kidney disease, such as chronic kidney disease. If you have a history of kidney disease, talk with your doctor before starting Plaquenil. Your body gets rid of Plaquenil through your kidneys. So if you have kidney disease, your body may not be able to get rid of the drug as quickly as it should. Because of this, your levels of Plaquenil may be too high, which could become toxic. If you have a history of kidney disease, talk with your doctor before starting Plaquenil. They may recommend a dosage of the drug for you that’s lower than usual. Or they may monitor your kidneys more often than usual during treatment.
  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency. G6PD is a protein that keeps your red blood cells healthy. People with G6PD deficiency don’t have enough G6PD. And if they take Plaquenil, their red blood cells may burst. This can lead to anemia (low red blood cell level). If you have G6PD deficiency, talk with your doctor before starting Plaquenil. They may monitor your blood more often during treatment. Or they may recommend a medication other than Plaquenil to treat your condition.
  • History of skin conditions, such as dermatitis. If you have a history of skin conditions such as dermatitis (a rash on the skin from irritation or allergy), you may have an increased risk of rash from Plaquenil. In some cases, rashes from Plaquenil may be serious. If you have a history of any skin conditions, talk with your doctor before starting Plaquenil. They may monitor you more often during treatment for signs of skin issues.
  • Psoriasis. If you have psoriasis, talk with your doctor before starting Plaquenil. In some cases, this drug may worsen psoriasis. Your doctor may recommend a medication other than Plaquenil to treat your condition.
  • Allergic reaction. If you’ve had an allergic reaction to Plaquenil or any of its ingredients, you shouldn’t take Plaquenil. You should also avoid taking Plaquenil if you’ve had a reaction to drugs called 4-aminoquinoline drugs, such as chloroquine. Ask your doctor what other medications are better options for you. And if you’re not sure about your medication allergies, talk with your doctor.
  • Pregnancy. It’s not known if Plaquenil is safe to take during pregnancy. For more information, please see the “Plaquenil and pregnancy” section above.
  • Breastfeeding. It isn’t known if Plaquenil is safe to take while you’re breastfeeding. For more information, please see the “Plaquenil and breastfeeding” section above.

Note: For more information about the potential negative effects of Plaquenil, see the “Plaquenil side effects” section above.

You may wonder how Plaquenil compares with other medications that are prescribed for similar uses. Here we look at how Plaquenil and chloroquine are alike and different.

Ingredients

Plaquenil contains the active drug hydroxychloroquine. Chloroquine, on the other hand, is an active drug that’s available as a generic medication. Chloroquine used to be available in the past as the brand-name medication Aralen. But that medication has been discontinued.

Plaquenil and chloroquine both belong to a group of medications called antimalarial drugs.

Uses

Both Plaquenil and chloroquine are approved to prevent and treat malaria. For this use, both drugs can be given to adults and children of any age. But Plaquenil shouldn’t be used in children who weigh less than 31 kilograms (about 68 pounds).

In addition, Plaquenil is also approved to treat certain types of lupus and rheumatoid arthritis (RA) in adults.

Chloroquine is also approved to treat certain types of amebiasis. This is a parasitic infection.

Note: For more information about the conditions mentioned here and certain limitations of Plaquenil’s use, see the “Plaquenil uses” section above.

Drug forms and administration

Both Plaquenil and chloroquine come as tablets that are taken by mouth.

For malaria prevention, Plaquenil and chloroquine are each taken once per week. For malaria treatment, Plaquenil and chloroquine are each taken once, followed by doses 6 hours, 24 hours, and 48 hours after the first dose.

Side effects and risks

Plaquenil and chloroquine both contain drugs that treat or prevent malaria. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Plaquenil, with chloroquine, or with both drugs (when taken individually).

  • Can occur with Plaquenil:
    • fatigue (lack of energy)
    • feeling nervous or irritable
    • weight loss
    • dizziness
  • Can occur with chloroquine:
  • Can occur with both Plaquenil and chloroquine:
    • nausea, vomiting, or diarrhea
    • belly pain
    • headache
    • hair loss

Serious side effects

These lists contain examples of serious side effects that can occur with Plaquenil, with chloroquine, or with both drugs (when taken individually).

Effectiveness

Plaquenil and chloroquine have different approved uses. But they’re both used to prevent and treat malaria.

These drugs haven’t been directly compared in clinical studies. But separate studies have found both Plaquenil and chloroquine to be effective in treating and preventing malaria.

The manufacturers of Plaquenil and chloroquine didn’t report the effectiveness of these drugs in people with malaria. This is because both drugs were approved during a time period when clinical studies for effectiveness weren’t done.

The Centers for Disease Control and Prevention (CDC) recommends both chloroquine and hydroxychloroquine for preventing and treating malaria. However, these drugs should only be taken for malaria in areas of the world where malaria isn’t resistant to the drugs. (With resistance, the infection doesn’t respond to a certain treatment.)

Costs

Plaquenil costs significantly more than chloroquine. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Plaquenil is a brand-name drug. A generic form of Plaquenil, called hydroxychloroquine, is also available. (A generic drug is an exact copy of the active drug in a brand-name medication.) Chloroquine is an active drug that’s available as a generic medication.

Brand-name medications usually cost more than generics cost.

You may wonder how Plaquenil compares with other medications that are prescribed for similar uses. Here we look at how Plaquenil and Humira are alike and different.

Ingredients

Plaquenil contains the active drug hydroxychloroquine, while Humira contains the active drug adalimumab.

Plaquenil belongs to a group of medications called antimalarial drugs. Humira, on the other hand, belongs to a group of drugs called biologics. (Biologic drugs are made from living cells, unlike non-biologics, which are made from chemicals.)

Uses

Here’s a list of uses that the Food and Drug Administration (FDA) has approved Plaquenil and Humira for:

Note: For more information about the conditions mentioned here and certain limitations of Plaquenil’s use, see the “Plaquenil uses” section above.

Drug forms and administration

Plaquenil comes as tablets that are taken by mouth, usually once or twice daily.

Humira comes as a solution that’s injected under the skin (a subcutaneous injection). It’s taken once every other week.

Side effects and risks

Plaquenil and Humira both contain medications that are used to treat RA. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Plaquenil, with Humira, or with both drugs (when taken individually).

  • Can occur with Plaquenil:
    • nausea, vomiting, or diarrhea
    • belly pain
    • fatigue (lack of energy)
    • dizziness
    • feeling nervous or irritable
    • hair loss
    • weight loss
  • Can occur with Humira:
    • upper respiratory infections, such as a cold
    • injection site reactions, such as redness
  • Can occur with both Plaquenil and Humira:
    • headache

Serious side effects

These lists contain examples of serious side effects that can occur with Plaquenil, with Humira, or with both drugs (when taken individually).

* Humira has a boxed warning regarding the risk of serious infections and cancer. A boxed warning is the strongest warning required by the FDA. Boxed warnings alert doctors and patients about drug effects that may be dangerous.

Effectiveness

Plaquenil and Humira have different FDA-approved uses, but they’re both used to treat RA.

These drugs haven’t been directly compared in clinical studies. But separate studies have found both Plaquenil and Humira to be effective in treating RA.

The manufacturer of Plaquenil didn’t report the drug’s effectiveness in treating RA. This is because Plaquenil was approved in 1955, and at that time, clinical studies for effectiveness weren’t done.

However, one trial looked at people with RA who took Plaquenil. The trial showed that after 36 weeks of taking the drug, people had decreased joint pain and increased joint function.

In addition, the American College of Rheumatology recommends Plaquenil, and other disease-modifying antirheumatic drugs (DMARDs), for treating RA. (DMARDs are a group of medications used to treat RA.) In some cases of RA treatment, DMARDs may be used along with other medications.

In one study, Humira was effective in treating RA in people who didn’t have improvement in the condition after taking DMARDs. (Plaquenil belongs to this group of drugs.)

Costs

Plaquenil costs significantly less than Humira. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Plaquenil and Humira are both brand-name drugs. A generic form of Plaquenil, called hydroxychloroquine, is currently available. (A generic drug is an exact copy of the active drug in a brand-name medication.)

There are currently no generic forms of Humira, but there are biosimilars. This is because Humira is a biologic drug. A generic drug is an exact copy of the active drug in a brand-name medication that’s made from chemicals. A biosimilar drug, on the other hand, is a medication that’s similar to a brand-name biologic drug. (Because biologic drugs are made from living cells, it’s not possible to copy these drugs exactly.)

Biosimilars for Humira have been approved by the FDA, but may not be available to people in the United States for several years.

Brand-name medications usually cost more than generics cost.

Plaquenil is approved for the following uses:

  • treating certain types of lupus in adults
  • treating rheumatoid arthritis (RA) in adults
  • preventing or treating malaria in adults and children of all ages who weigh at least 31 kilograms (about 68 pounds)

In some cases of RA or lupus treatment, Plaquenil may be used along with steroids, such as prednisone. And it may also be used with salicylates, such as aspirin.

For certain forms of malaria, Plaquenil is typically used in combination with a drug called primaquine. But for other forms of malaria, Plaquenil may be used by itself. Your doctor will recommend whether to take Plaquenil by itself or with other drugs.

When other medications are taken in addition to Plaquenil, your doctor may decrease your dosage of the other drugs once Plaquenil begins working. In some cases, your doctor may even recommend that you stop using certain other drugs.

If you have questions about drugs you may be taking with Plaquenil, talk with your doctor. They can recommend a treatment plan that’s right for you.

Using more than the recommended dosage of Plaquenil can lead to serious side effects.

Do not use more Plaquenil than your doctor recommends.

If you or someone you know has taken too much Plaquenil, go to the hospital right away. Plaquenil doses of 750 mg to 1,000 mg have been fatal in children.

Overdose symptoms

Symptoms of an overdose can include:

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

When you get Plaquenil from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Plaquenil tablets should be stored at room temperature up to 86°F (30°C). They should be kept in a tightly sealed container away from light. For short periods of time, this drug can be stored between 59°F and 86°F (15°C and 30°C). Avoid storing Plaquenil in areas where it could get damp or wet, such as in bathrooms.

Disposal

If you no longer need to take Plaquenil and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

The following information is provided for clinicians and other healthcare professionals.

Indications

Plaquenil is indicated for the following uses:

  • treatment of chronic discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE) in adults
  • treatment of acute and chronic rheumatoid arthritis (RA) in adults
  • prevention and treatment of malaria in adults and children of any age who weigh at least 31 kilograms

Limitations of use for malaria

For malaria, Plaquenil has the following limitations of use:

  • This drug is not meant to be used for complicated cases of malaria. Plaquenil should only be used in people with uncomplicated infections.
  • This drug is not effective for strains of malaria resistant to either chloroquine or hydroxychloroquine. In addition, Plaquenil should not be used to treat or prevent malaria infections that were acquired in areas where malaria does not improve with chloroquine.
  • This drug should not be used for malaria infections acquired in areas where Plasmodium species of malaria are not present.
  • This drug should not be used to prevent relapses of malaria caused by P. vivax or P. ovale as Plaquenil is not effective against these types of infections. If Plaquenil is used for these infections, treatment containing 8-aminoquinoline must be used in combination with Plaquenil.

Administration

Plaquenil is an oral tablet that is taken by mouth. It should be taken with a meal or glass of milk.

Mechanism of action

It is not known exactly how Plaquenil works to treat lupus, rheumatoid arthritis (RA), or malaria. It is also unknown how the drug prevents malaria.

Plaquenil may work against malaria by acting as a weak base. The malaria parasite works by polymerizing heme inside red blood cells. Plaquenil may work by neutralizing the acid in the parasite, which blocks the polymerization step. It may also block DNA and interact with enzymes in the body.

It is not known how Plaquenil works to improve symptoms of lupus or RA.

Pharmacokinetics and metabolism

After a dose of Plaquenil, the maximum drug concentration in the blood was seen at about 3.26 hours post-dose. The absorption half-life of the drug is 3 to 4 hours.

The drug’s half-life in the blood after a single dose is estimated at 123.5 days. The terminal half-life of Plaquenil is very long, at 40 to 50 days. This is because the drug permeates into the tissue. It is broken down into three main metabolites, with desethylhydroxychloroquine being the most common.

The drug has a range of absorption levels in people with RA, ranging from 30% to 100%.

Contraindications

Plaquenil is contraindicated for use in people with allergies to 4-aminoquinoline drugs.

Storage

Plaquenil tablets should be stored at room temperature up to 86°F (30°C) in a tightly sealed container away from light. For short periods of time, this drug can be stored between 59°F and 86°F (15°C and 30°C). Plaquenil should not be stored in areas where it could get damp or wet, such as in bathrooms.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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