Plaquenil
Generic available: no
Tablet size: 200 mg
Usual dose: one or two pills daily
Effective within: six weeks to six months
The healing qualities of quinine have been recognized for centuries. Quinine and its derivatives have been used to treat skin ailments, fever, and, notably, malaria. Commonly used anti-malarial drugs are hydroxychloroquine, chloroquine, and quinacrine. Quinacrine was the first anti-malarial used (in the 1950s) to treat RA. Chloroquine and hydroxychloroquine are both used today in treating RA. Hydroxychloroquine has become more popular because it causes few side effects.
Side effects of hydroxychloroquine. Hydroxychloroquine may be the safest of the DMARDs. Estimates are that only 5 percent of patients discontinue using the medication because of its side effects. The most commonly reported side effects of hydroxychloroquine are nausea, decreased appetite, diarrhea, and rash. Most of these problems can be eliminated with dose changes and by taking the medication at mealtime.
The principal concern with all anti-malarial drugs is the risk of eye problems (retinopathy). With long-term use, these medications can cause changes in the eye’s retina. When hydroxychloroquine is taken in the customary dose for RA, however, the risk of this is exceedingly small. Dr. Howard Bernstein of Bethesda, Maryland, reports that the risk of retinopathy for patients taking 400 mg per day of hydroxychloroquine is less than 0.5 percent. When eye examinations are performed by an ophthalmologist every six months and the medication is discontinued immediately on the ophthalmologist’s advice, the risk of permanent eye damage approaches 0 percent. Chloroquine use involves a slightly higher risk of permanent eye damage.
Your ophthalmologist may also mention that he or she has detected deposits on the cornea. This appears to be a reversible side effect that does not warrant a change in therapy.
When hydroxychloroquine is first taken, your vision may be temporarily blurred. This does not mean that there is a problem with your retina; the blurring will clear within a week.
Before starting hydroxychloroquine therapy discuss the following with your physician:
•      A history of psoriasis, liver disease, porphyries, or eye problems.
•      Any medications that you are presently taking, particularly the heart medication digoxin.
•      If you have been diagnosed as having glucose-6-phosphate dehydrogenase (6-PD) deficiency. This condition appears in approximately 10 percent of black people and in some people of Mediterranean background. A blood test for G-6-PD deficiency can be performed before you start treatment with hydroxychloroquine.
•      A baseline examination (an examination performed before treatment begins) by an ophthalmologist is recommended.
While taking hydroxychloroquine:
•      Contact your physician promptly if you notice a change in vision, a rash, muscle weakness, fever, or easy bleeding or bruising.
•      Avoid unprotected or prolonged exposure to the sun.
•      You should be checked by an ophthalmologist every six months while taking this medication. (The manufacturer of Plaquenil recommends an ophthalmologic examination every three months.)
Pregnancy and breastfeeding. Because the eyes of the fetus can be (rarely) affected by hydroxychloroquine, it is recommended that use of this medication be avoided during pregnancy. Hydroxychloroquine is excreted in breast milk, and therefore mothers should discontinue either nursing or use of the medication.
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