Hydroxychloroquine is a medication used to treat pain and swelling caused by rheumatoid arthritis and other inflammatory disorders. This medication may also prevent long-term joint damage and other complications of the disease.

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Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes swelling and pain in the joints of the hands, wrists, and feet. The effect of RA on the body can range in severity and go through periods of remission or flare-ups.

Hydroxychloroquine is a medication doctors prescribe to treat people with mild RA. Here’s what you need to know about this medication, how it works, and what side effects you may experience while taking it.

Learn more about Rheumatoid arthritis.

Hydroxychloroquine (brand name Plaquenil) was originally marketed as a treatment for malaria. It’s categorized as a disease-modifying anti-rheumatic drug (DMARD) and — over the years — has earned a spot as an effective treatment for autoimmune conditions like RA and lupus.

Most people tolerate the medication without significant side effects, so it’s a safe option for treating both adults and children. It’s also widely available and relatively cost-effective.

Hydroxychloroquine: Not for COVID-19

During the pandemic, hydroxychloroquine was touted as a treatment option for COVID-19. However, according to the FDA, the current treatment guidelines recommend against the use of hydroxychloroquine for COVID-19 due to a lack of firm evidence.

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RA is caused by an overactive immune system. Hydroxychloroquine blocks the inflammation-causing chemicals the immune system releases when it attacks the body. In other words, the medication helps modulate and calm the immune system.

For people with rheumatoid arthritis, this medication may:

  • reduce swelling
  • ease pain
  • reduce stiffness in joints
  • lessen inflammation
  • prevent joint damage
  • reduce the risk of disability

Hydroxychloroquine may be used on its own or combined with another DMARD (like methotrexate), depending on a person’s symptoms.

You may be encouraged to have a vision exam before taking hydroxychloroquine and to follow up with exams annually. This is to help track any vision changes that may occur over the course of taking the drug.

You should also speak with your healthcare professional if you’re pregnant, nursing, or trying to conceive. Some sources say this medication is safe, while others say it may lead to birth defects if taken in the first trimester of pregnancy.

Hydroxychloroquine is available in the form of a tablet to take by mouth. According to the American College of Rheumatology, dosages range from 200–400 milligrams (mg) a day — 5 mg/kg with a maximum of 400 mg each day.

Dosages may be taken once a day or split into two equal doses. Some people may need a higher dose as directed by a doctor.

The tablet should be taken with food. You should also leave 4 hours between taking hydroxychloroquine and any antacids.

The most common side effects of hydroxychloroquine are nausea and diarrhea. Eating food — particularly fatty food, like butter — can help with these issues.

Other potential side effects:

Vision changes and vision loss are other rare side effects primarily seen in people who have taken the drug for a long time or are taking high doses. These side effects may also be experienced by people who:

  • have underlying retinal disease
  • have kidney disease
  • have liver disease
  • are over 60 years old

Hydroxychloroquine may interact with some epilepsy medications, like carbamazepine or phenytoin, or heart medications — specifically antiarrhythmics — such as amiodarone or digoxin.

To avoid rare side effects, you should speak with your doctor before taking hydroxychloroquine if you:

Let your doctor know about any daily medications and supplements you’re taking that may interact with the drug.

RA symptoms generally improve within the first 2 months of taking hydroxychloroquine. The change may be slow, so it’s important to keep taking the medication as prescribed by your doctor.

The full benefits hit after about 6 months of taking the medication. If symptoms haven’t improved in this time period, speak with your doctor about reviewing your treatment plan.

Again, hydroxychloroquine is the generic form of Plaquenil.

How much you pay will depend on your health insurance, other prescription drug coverage, and the pharmacy you choose. Contact your insurance provider for more details.

A discount prescription card program may be an alternative to assist with high copays.

How long will I need to take hydroxychloroquine?

RA is a chronic condition. You may need to continue taking the medication to experience the benefits and prevent complications. Your doctor is your best resource for how long to take the medication and how to discontinue its use.

Are there any lifestyle changes that can help with RA?

Getting regular exercise, eating a nutritious and balanced diet, and getting enough rest during flare-ups may help with RA. And if you smoke, quitting may also reduce your symptoms.

Is hydroxychloroquine an immunosuppressant?

No. Hydroxychloroquine does not directly suppress the immune system. That said, it may affect a person’s white blood cell count and make infection more likely.

Without treatment, RA can lead to complications like carpal tunnel syndrome, inflammation in the organs (heart, lungs), and permanent tissue damage.

Hydroxychloroquine may prevent these complications and is considered an effective treatment that most people can take safely. If you have RA, speak with your doctor to find out if hydroxychloroquine is an appropriate treatment option for you.