Prescriptions 101: Plaquenil

It's been awhile since I did a prescription post. So for those who have been anxiously awaiting the next entry...here you go! The medicine up for review: Plaquenil.

Hydroxychloroquine (brand name Plaquenil) is considered an antimalarial drug used to reduce inflammation in the treatment of Rheumatoid arthritis and lupus. It isn't clear how it works, but the drug is a disease-modifying drug (DMARD or disease-modifying anti-rheumatic drug) meaning that it's designed to decrease pain or swelling caused by the disease in question.

I've been on plaquenil for a total of about 3 1/2 years since my diagnosis. This latest run (from June 2007 to present) has been very successful, and side-effects have been non-existent. In addition, I've had little to no disease activity since I've been on it, and my present dosage is 400 mg (200mg twice a day). In fact, it's been so effective that it's one of only two prescriptions I'm on right now (5 mg maintenance dose of prednisone every other day being the other one.) I also take a baby aspirin and calcium supplements daily, and although my doctor just added a prescription for a vitamin D supplement...I don't count it, since it has no effect on my disease activity.

However, the last time I took plaquenil, I didn't have as much success, for two reasons:

One - after being on Plaquenil for about a year and a half (at a dosage of 600mg for the majority of the time), the drug started adversely affecting my eyes. I knew retinal changes were possible, but it was such an uncommon side-effect that none of my doctors nor I were worried. However, my eye doctor discovered a change in my eyes after 18 months and recommended I stop taking the drug immediately. Because the changes to the eye caused by Plaquenil are usually reversible, after less than six months of stopping the drug, my eyes returned to normal.

Two - even when I was on the drug, I still had some degree of disease activity AND I was on several other prescriptions at the time to keep away pain, swelling, etc. This first time around, I wasn't that thrilled with the drug...which was a bummer...because a lot of lupus patients swear by it.

Because I'd had such a so-so experience with the drug the first time around - I was nervous about making the switch from CellCept (what I consider my miracle drug - see my previous post for more info) to Plaquenil back in June of 2007. (CellCept isn't safe to use during pregnancy.) Much to my relief, the transition was seamless and I had absolutely no disease flare-up at all. (Note that my lifestyle was much more accommodating than it was the first time, and I know that made a big difference!) When I made the switch, my eye doctor felt that going back on the drug for a short period of time (pregnancy) would not be harmful to my eyes, and he was right. In fact. my eyes have not been affected in any way, so I'm sticking with plaquenil for now. It's a lot cheaper than CellCept - and my body is responding favorably. I guess you can consider me a convert.

Dosage: I started at 200mg, have been on as much as 600mg (when 400mg wasn't doing the trick), but have now had much success with my present dosage of 400mg.

Known Side Effects:

Side-effects that should be brought to your doctor's attention:
allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue•change in vision•fever, infection•hearing loss or ringing•muscle weakness, tremor, or numbness•redness, blistering, peeling or loosening of the skin, including inside the mouth•seizures•unusual bleeding or bruising•unusually weak or tired

Side effects that typically don't require medical attention (but can be bothersome, nonetheless):
change in coloration of the mouth or skin•dizziness•hair loss, lightening•headache•irritability, nervousness, nightmares•loss of appetite•stomach upset, diarrhea

Administering: This is an easy one - as it requires no special food or drink. It's simply recommended that you take it with water and at the same time everyday.

Cost: Moderate, in my book. $100 - $199, however my insurance covers almost 2/3 of that cost.

Limitations: It typically takes up to 2 months (and sometimes up to 6 months) to see the results of Plaquenil. I experienced pain relief right around the 6 week mark.

Also note that my pharmacy offers two different manufacturers of the drug - and I much prefer Mylan. The other manufacturer's pills leave a terrible taste in my mouth. Thankfully my pharmacist knows which one I prefer now!

Additionally, when I became pregnant, Plaquenil was not on the approved list for breast-feeding drugs. (Safe for pregnancy, if medically necessary, but not for nursing. I'll explain why in a future post.) However, during the course of my pregnancy, it was switched into the safe category. Guess those 9 months were necessary!

Another interesting note: When Johnny and I traveled to South Africa a few years ago, with plans to go to Kruger National Park where there is a malaria risk, we had to get prescriptions for anti-malaria drugs. I wasn't on plaquenil at the time, but I mentioned the fact that I'd taken it in the past - just in case there was a concern of a drug interaction with another anti malaria drug and my other medication. The nurse practitioner in my doctor's office recommended we go with Malarone, instead - guess it's known to have fewer side-effects.

For more information, check out the following article: 10 Things You Need to Know about Plaquenil.