Hydroxychloroquine

Sounds like 'hi-DROX-ee-KLOR-oh-kwin'

Easy-to-read medicine information about hydroxychloroquine – what it is, how to take it safely and possible side effects.

Type of medicine Also called
  • Belongs to a class of medicines known as disease-modifying antirheumatic drugs (DMARDs)
  • Antimalarial (for malaria) 
  • Plaquenil®

What is hydroxychloroquine?

Hydroxychloroquine is used to treat rheumatoid arthritis and lupus. In rheumatoid arthritis, it helps to reduce pain, stiffness and swelling of your joints and in this way reduces damage to your joints. Hydroxychloroquine is also used to treat or prevent malaria. In New Zealand hydroxychloroquine is available as tablets (200 mg).

Watch a video about hydroxychloroquine for rheumatic diseases.

Hydroxychloroquine currently has no role in the management of COVID-19
There has been a lot of interest around the use of hydroxychloroquine for the treatment of COVID-19. There has not been any specific evidence to confirm its efficacy for this use. Using medicines unnecessarily creates a shortage for patients using them for established uses such as rheumatoid arthritis or malaria. Read more about COVID-19 and your medicines.

Dose

  • Rheumatoid arthritis or lupus: Your doctor may start you on a higher dose (2 to 4 tablets daily) and reduce it after a few weeks. The usual dose of hydroxychloroquine is 1 or 2 tablets daily, although your dose may differ from this. 
  • Malaria: The dose of hydroxychloroquine for malaria is different.
  • Always take your hydroxychloroquine exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much hydroxychloroquine to take, how often to take it and any special instructions.

How to take hydroxychloroquine

  • Take hydroxychloroquine at the same times each day, with a full glass of water or a glass of milk (to help reduce nausea or feeling sick).
  • It is best to take hydroxychloroquine with or after food, but do not take it with antacids (medicines for heartburn).
  • If you forget to take your dose, take it as soon as you remember. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.
  • Keep taking hydroxychloroquine every day. It may take up to a few months before you experience the full benefits of hydroxychloroquine.

Increased sensitivity to the sun

Hydroxychloroquine can make you more sensitive to the sun and your skin is more likely to burn.

  • Avoid unnecessary sun exposure.
  • When outside, protect your skin by using an oil-free sunscreen (SPF30+). Apply the sunscreen to all areas especially your face, neck and ears. Read more about using sunscreen.
  • Wear clothing that protects you from the sun.
  • Wear sunglasses when outdoors.

Precautions – before starting hydroxychloroquine

  • Do you have psoriasis, epilepsy, myasthenia gravis or diabetes?
  • Do you have problems with your stomach, liver, kidneys or heart rhythm?
  • Do you have an eye condition called maculopathy or retinopathy?
  • Are you pregnant or breastfeeding?
  • Are you taking any other medicines? This includes any medicines you are taking that you can buy without a prescription, as well as herbal and complementary medicines.

If so, it’s important that you tell your doctor or pharmacist before you start hydroxychloroquine. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Possible side effects

Like all medicines hydroxychloroquine can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine. Read more about what to expect when starting hydroxychloroquine. 

Problems with your eyesight

Hydroxychloroquine can affect your eyesight. Blurred vision may occur in the first few weeks after starting it. This usually returns to normal even when you continue taking the tablets. Talk to your doctor if you are worried. 

Taking hydroxychloroquine over a long time (more than 5 years) can cause damage to your eyes. You will need an eye test in your first year of treatment, and another one after 5 years (unless your doctor decides you need one sooner).

After 5 years of treatment, you will need to have an eye test every year. If you notice any changes in your eyesight, such as sensitivity to light, blurred vision, seeing light flashes, streaks or black spots, tell your doctor as soon as possible. Also wear sunglasses when in bright sunlight to protect your eyes.

Other side effects

Side effects What should I do?
  • Nausea (feeling sick)
  • Stomach upset
  • Take hydroxychloroquine with food or a glass of milk.
  • Headache
  • Dizziness
  • Sit down for a while until the feeling of dizziness passes.
  • Tell your doctor if troublesome.
  • Changes to your heart rate   
  • Tell your doctor immediately or phone Healthline 0800 611 116. 
  • Changes to your hair, skin or nails
  • Tell your doctor.
  • Emotional or mood changes 
  • Tell your doctor immediately or phone Healthline 0800 611 116. 
  • Signs of an allergic reaction such as skin rashes, itching, blisters, peeling skin, swelling of your face, lips or mouth or having problems breathing
  • Tell your doctor immediately or phone Healthline 0800 611 116. 

Interactions

Hydroxychloroquine interacts with a few medicines and herbal supplements so check with your doctor or pharmacist before starting hydroxychloroquine and before starting any new medicines. Do not take antacids within 4 hours (before or after) of taking hydroxychloroquine.

Learn more

The following links have more information on hydroxychloroquine.

Hydroxychloroquine (for rheumatoid arthritis) New Zealand Formulary
Hydroxychloroquine – what you can expect when starting treatment
Medsafe, NZ
Plaquenil Medsafe Consumer Information, NZ

References

  1. Hydroxychloroquine New Zealand Formulary
  2. Risks of hydroxychloroquine Medsafe, NZ, 2015 
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 03 Jun 2019