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Hydroxychloroquine

Drug Class: Commonly Known As: Category:
Hydroxychloroquine Adult

Hydroxychloroquine - What is it for

Hydroxychloroquine belongs to a class of medicines called disease modifying anti-rheumatic drugs (DMARDs). DMARDs reduce symptoms such as pain and swelling and slow down the progress of certain autoimmune diseases (disease where the body's natural defence system attacks own body cells) such as:

  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Systemic sclerosis
  • Sjögren syndrome

In the long term, it reduces permanent damage to the organs such as joints, lung and skin. It may be used on its own or in combination with other DMARDs or biologic agents.

Hydroxychloroquine - Side Effects, Precautions, and Contraindications

What side effects can Hydroxychloroquine cause?

Side effects may occur when taking Hydroxychloroquine, but the majority of these effects tend to resolve spontaneously. Common side effects include:

  • Nausea, vomiting and stomach upset (Can be minimized by taking Hydroxychloroquine after food or with milk)
  • Headache
  • Dizziness
  • Skin rash
  • Skin pigmentation
  • Hair changes (Bleaching or thinning of hair)
  • Transient blurring of vision (This usually resolves spontaneously in one to two weeks)

Consult your doctor or pharmacist about any symptoms that becomes bothersome.

Before taking Hydroxychloroquine, what precautions must I follow?

Inform your doctor or pharmacist if you have G6PD (glucose-6-phosphate dehydrogenase) deficiency or porphyria (group of diseases in which substances called porphyrins build up, negatively affecting the skin or nervous system), as Hydroxychloroquine may not be suitable for you.

Come back to the hospital for regular blood test as instructed by your doctor.

Your doctor also may suggest regular eye exams while taking this medication. Visual changes experienced early on or seen early during regular eye exams usually improve after stopping the medication.

Because adverse effects can happen at any time during the course of treatment and some side effects may not cause symptoms, it is really important that you have your regular blood and eye test. 

What food or medicine must I avoid when I take Hydroxychloroquine?

​Hydroxychloroquine may interact with other medicine or supplement that you are taking. Inform the doctor, pharmacist or specialty nurse (such as dermatology or rheumatology) before starting any medicines and supplements.

Your doctor may reduce your Colchicine dose when taken with medicines such as Tamoxifen (a medicine to treat breast cancer), as they might increase the chance of you experiencing severe side effects.

Hydroxychloroquine - Dosage and How to Use

How should Hydroxychloroquine be used?

Hydroxychloroquine should be taken as prescribed by the doctor. It is given orally, after food, usually once or twice daily.

A typical adult dose ranges from 200 milligrams to 400 milligrams daily. Your doctor may reduce the dose if you have kidney problem.

You may start to see improvement within a few weeks, but it may take up to several months to experience its full benefit.

What should I do if I miss a dose?

If you forget to take the tablet, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose. Resume the next dose at the regular timing. Do not take a double dose to make up for a forgotten tablet.

What should I do if I overdose?

Hydroxychloroquine - Handling and Storage

How should I handle Hydroxychloroquine safely?

How should I store Hydroxychloroquine?

Keep away from children;#Keep in a cool, dry place, away from direct sunlight;#Store at room temperature;#

How should I dispose of Hydroxychloroquine safely?

Hydroxychloroquine - Additional Information

How LONG does it take for the medicine to be EFFECTIVE?

You may start to see improvement within a few weeks, but it may take up to several months to experience its full benefit.

What are the SPECIAL precautions while taking the medicine?

Inform your doctor or pharmacist if you have G6PD (glucose-6-phosphate dehydrogenase) deficiency or porphyria (group of diseases in which substances called porphyrins build up, negatively affecting the skin or nervous system), as Hydroxychloroquine may not be suitable for you.

STOP taking Hydroxychloroquine and let your doctor know if you develop an allergic reaction. Rash due to allergic reaction to Hydroxychloroquine is rare. Possible symptoms of allergic reaction are:

  • rash, hives, or itching
  • red, swollen, blistered or peeling skin with or without fever
  • wheezing or tightness in the chest or throat
  • trouble breathing or talking
  • unusual hoarseness
  • swelling of the mouth, face, lips, tongue or throat

STOP taking Hydroxychloroquine and seek medical attention immediately if you experience any of the rare but severe side effects:

  • Eye problems
    • Damage to the retina (cell layer at the back of the eye) may occur. Affected persons may notice blurring or loss of vision especially the centre part of an object or word, flashing light and colour deficit specifically red objects.
    • This eye problem are more likely to occur in persons with risk factors such as in those taking high doses for many years or in those with severe kidney disease. Nowadays, the dose used is lower (less than 5 mg/kg actual body weight/day) than it was originally used to treat diseases, hence, development of eye problem while taking this medicine is extremely unusual.
    • In addition, this risk is greatly reduced by regular eye check-up and following the doctor's instruction on daily dosage. Any eye changes experienced and reported early or recognised early during regular eye check-up usually improve after stopping the medicine.

While having treatment with Hydroxychloroquine, you must see your doctor as scheduled, including any eye check-up to monitor response to treatment and minimize any possible side effect.

Can I take other MEDICINES or SUPPLEMENTS?

Hydroxychloroquine may interact with other medicine or supplement that you are taking. Inform the doctor, pharmacist or specialty nurse (such as dermatology or rheumatology) before starting any medicines and supplements.

Your doctor may reduce your Colchicine dose when taken with medicines such as Tamoxifen (a medicine to treat breast cancer), as they might increase the chance of you experiencing severe side effects.

What special DIETARY instructions should I follow?

Alcohol should be avoided if possible or kept to a minimum as suggested by your rheumatologist because alcohol may increase the risk of gastrointestinal side effects associated with hydroxychloroquine.

Can I get PREGNANT or BREASTFEED?

For female patient, do inform your doctor if you are pregnant, planning for pregnancy or breastfeeding. Hydroxychloroquine can be continued during pregnancy and breastfeeding.

In SUMMARY… what you need to know about hydroxychloroquine?

  • Take hydroxychloroquine once daily, approximately the same time each day.
  • Always come for your BLOOD TESTS and EYE EXAMINATIONS on the scheduled date.
  • Beware of the SIDE EFFECTS and when to get immediate medical attention.
  • Never take medicines, supplements or herbal treatments OVER-THE-COUNTER without checking with your doctor or pharmacist first.
  • For female patient intents to start a family, please inform your doctor.
  • If you have further questions about Hydroxychloroquine, please call ______________________ (office number) to discuss with your doctor / pharmacist / specialty nurse (please circle as appropriate).
  • Updated on Friday, June 12, 2015
  • This article is contributed by Department of Pharmacy, Rheumatology & Immunology Singapore General Hospital

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