How does hydroxychloroquine work for Lupus?

In this article:

• What does hydroxychloroquine do for Lupus?
• Side effects
• Dosage
• Interactions
• Alternatives

In this article

• What does hydroxychloroquine do for Lupus?
• Side effects
• Dosage
• Interactions
• Alternatives

Hydroxychloroquine is a generic prescription drug approved by the U.S. Food and Drug Administration (FDA) to treat malaria, rheumatoid arthritis, and erythematosus lupus. It’s also sold under the brand name Plaquenil. Hydroxychloroquine is considered a first-line treatment for autoimmune inflammatory conditions such as lupus. It’s been shown to reduce lupus flare-ups and help prevent long-term damage from flares.

RELATED: What is Hydroxychloroquine Sulfate: Uses, Warnings & Interactions

What does hydroxychloroquine do for Lupus?

Lupus is an autoimmune condition in which the immune system mistakenly attacks the body’s own healthy tissues. According to the Lupus Foundation of America (LFA), there are four different types of lupus, which include: 

• Systemic lupus erythematosus (SLE)
• Cutaneous lupus, which causes skin problems
• Drug-induced lupus 
• Neonatal lupus 

The most common is SLE, which is often treated with hydroxychloroquine. Systemic lupus erythematosus can range from mild to severe and involves inflammation of multiple systems in the body. Inflammation can be acute (joint pain during a lupus flare, for example) or chronic.

“Hydroxychloroquine is a cornerstone medication used in the treatment of lupus,” says board-certified rheumatologist Joseph R. Martinez, MD, of Texas Orthopedics. According to the LFA, hydroxychloroquine is so effective that patients are on it for a long time—even for life. 

Though the drug’s mechanism of action is complex and still not fully understood, according to a 2022 research review published in Therapeutic Advances in Musculoskeletal Disease, the beneficial effect is clear: hydroxychloroquine disrupts inflammatory pathways in people who have SLE.

“The role of hydroxychloroquine is to reduce inflammation, reduce inflammation flares, and prevent blood clots and organ damage,” explains Inna Melamed, Pharm.D., FASCP, a functional medicine practitioner and author of Digestive Reset. 

Hydroxychloroquine is not a fast-acting medication, so patience is important. Dr. Melamed says it takes six to 12 weeks to know if the drug is working, and Dr. Martinez estimates that it might take three to six months for patients to notice the benefits. 

Dr. Melamed says those benefits include reducing symptoms like pain and joint swelling, “The patient would also need the doctor to examine the joint swelling.” 

Side effects of hydroxychloroquine for lupus

Hydroxychloroquine is generally safe and well-tolerated, but it may still cause side effects. According to the American College of Rheumatology, the most common side effects when starting hydroxychloroquine are nausea and diarrhea. These should go away as your body adjusts to the new medication.

Other side effects associated with hydroxychloroquine use include:

• Headache
• Loss of appetite
• Stomach pain
• Vomiting
• Hearing problems
• Hair loss or hair color change

Less common but serious adverse effects from hydroxychloroquine include hypoglycemia, irreversible vision problems marked by blurred vision and black spots, heart rhythm problems, and thoughts of suicide. Get medical help from a healthcare provider immediately if any of these symptoms occur.

Weight gain is not a known side effect of hydroxychloroquine. Some people taking Plaquenil, a brand-name version of hydroxychloroquine, have reported weight loss as an adverse reaction to the drug.

Hydroxychloroquine for Lupus dosage

Hydroxychloroquine falls under two classifications: antimalarial drugs and disease-modifying antirheumatic drugs (DMARDs). The recommended dosage for hydroxychloroquine depends on the condition being treated. The most common dose for lupus patients is 200–400 mg per day.

Higher doses may be associated with a lower risk of flares. A 2022 study in the Journal of the American Medical Association suggested that patients taking a daily hydroxychloroquine (HCQ) dose below 5 milligrams (mg) per kilogram (kg) of body weight experienced more flares than those taking a higher dose. However, the 5 mg per kg guideline has been promoted to lower the risk of serious eye problems.

Only a healthcare provider with a complete picture of the patient’s medical history, conditions, and other prescription medications can decide the best dosage for each person with lupus. Most people with lupus take hydroxychloroquine or another DMARD for life. 

Never stop taking hydroxychloroquine or adjust your daily dose without seeking medical advice from a healthcare professional. Stopping hydroxychloroquine pills may cause worsening lupus symptoms and a higher risk of lupus flares.

Hydroxychloroquine risks and interactions

Hydroxychloroquine is not suitable for everyone. It is not recommended for anyone who has had an allergic reaction to hydroxychloroquine or other similar antimalarial drugs. Hydroxychloroquine may also be risky for people who have:

• Heart rhythm problems or heart disease
• A high risk for eye damage
• Psoriasis
• Porphyria or certain enzyme deficiencies
• A history of psychiatric conditions or thoughts of suicide
• Diabetes or a risk for low blood sugar

Before starting hydroxychloroquine, it’s essential to give your healthcare provider complete information about your family or personal medical history and any medications and supplements you take. Tell your healthcare provider if you are pregnant, planning to become pregnant, or breastfeeding. Also, ask your healthcare provider to explain the risks associated with hydroxychloroquine use, such as irreversible eye problems and dangerously low blood sugar. 

Drug interactions can occur while taking hydroxychloroquine. Anyone taking this prescription drug should avoid the following:

• Alcohol
• Tagamet (cimetidine), a stomach acid reducer
• Taking antacids within 4 hours of hydroxychloroquine
• Taking kaolin within 4 hours of hydroxychloroquine

Some medications can interfere with the way hydroxychloroquine works or increase the risk of serious side effects. Again, it is vital to tell your prescriber about any medicines, supplements, vitamins, and herbal remedies you’re taking before starting this drug. 

Research suggests hydroxychloroquine doesn’t increase sun sensitivity. However, according to the LFA, two-thirds of people with lupus are extra sensitive to ultraviolet rays. It’s a good idea for people with lupus to be vigilant about sun protection, whether or not they’re taking hydroxychloroquine.

Alternatives to hydroxychloroquine for lupus

Hydroxychloroquine isn’t the only medication used to treat lupus, but it is often the drug of choice. Dr. Martinez says alternative drugs do not work the same way but can be beneficial for specific, targeted areas of lupus, such as lupus of the kidneys.

People with lupus who cannot take hydroxychloroquine may be prescribed more than one drug as an alternative. Autoimmune diseases can vary from person to person, so it’s important to work with a healthcare provider to determine the best treatment plan for you.

Dr. Melamed says prescription alternatives to hydroxychloroquine for lupus include Saphnelo, a monoclonal antibody intravenous (IV) infusion, and Benlysta, a monoclonal antibody injection. “They have a very different mechanism of action and are quite pricey,” she notes. 

Other medications used to treat lupus include:

• Chloroquine (Aralen), another antimalarial
• Steroids such as prednisone, prednisolone, or methylprednisolone 
• Immunosuppressants such as methotrexate (Rheumatrex), mycophenolate mofetil (Cellcept), azathioprine (Imuran), cyclophosphamide (Cytoxan), or voclosporin (Lupkynis)

The experts agree: Though they’re no substitute for a prescription treatment plan, over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can relieve some lupus symptoms. “In the more integrative world, naturopathic physicians recommend Boswellia, turmeric, ginger root extract, and enzymatic anti-inflammatory blends,” adds Dr. Melamed. 

However, lupus affects everyone differently. Some forms are more severe than others and require particular medications for the best treatment results. Always consult a healthcare provider with expertise in autoimmune conditions like lupus before adding to or changing your treatment regimen.