Does Plaquenil (hydroxychloroquine) cause side effects?
Malarial parasites invade human red blood cells. Hydroxychloroquine may prevent malarial parasites from breaking down hemoglobin in human red blood cells. Hydroxychloroquine is effective against the malarial parasites Plasmodium vivax, P. malariae, P. ovale, and susceptible strains of P. falciparum.
Hydroxychloroquine also prevents inflammation caused by lupus erythematosus and rheumatoid arthritis. Hydroxychloroquine and its sister drug chloroquine (Aralen) are under investigation for treatment of the COVID-19 coronavirus disease but their effectiveness is currently unproven.
Common side effects of hydroxychloroquine include:
- hair lightening or loss,
- stomach upset,
- muscle pain,
- rash, and
Serious side effects of hydroxychloroquine include:
- possible worsening of psoriasis,
- reduced white blood cells (leukopenia) or platelets (thrombocytopenia) and abnormal red blood cells (anemia),
- serious eye toxicity that can lead to color blindness and loss of vision, and
- in certain patients who are genetically deficient in a certain enzyme severe anemia can occur.
Hydroxychloroquine suppresses the immune system and should not be combined with drugs that also suppress the immune system or live vaccines.
What are the important side effects of Plaquenil (hydroxychloroquine)?
PHYSICIANS SHOULD COMPLETELY FAMILIARIZE THEMSELVES WITH THE COMPLETE CONTENTS OF THE PRESCRIBING INFORMATION BEFORE PRESCRIBING HYDROXYCHLOROQUINE.
Side effects include:
- hair lightening or loss,
- stomach upset,
- muscle pain,
- rash and
Rarely, hydroxychloroquine can affect the bone marrow leading to reduced white blood cells (leukopenia) or platelets (thrombocytopenia) and abnormal red blood cells (anemia).
Rare but potentially serious eye toxicity can occur. This toxicity affects a part of the eye called the retina and can lead to color blindness and even loss of vision. An ophthalmologist (eye specialist) often can detect changes in the retina that suggest toxicity before serious damage occurs. Therefore, regular eye examinations, even when there are no symptoms, are mandatory.
Patients who are genetically deficient in a certain enzyme, called G6PD, can develop severe anemia resulting from the rupture of red blood cells. This enzyme deficiency is more common in persons of African descent and can be evaluated by blood testing. Hydroxychloroquine may worsen psoriasis.
Plaquenil (hydroxychloroquine) side effects list for healthcare professionals
The following adverse reactions have been identified during post-approval use of Plaquenil or other 4-aminoqunoline compounds. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Blood and lymphatic system disorders: Bone marrow failure, anemia, aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia. Hemolysis reported in individuals with glucose-6- phosphate dehydrogenase (G-6-PD) deficiency.
Cardiac disorders: Cardiomyopathy which may result in cardiac failure and in some cases a fatal outcome. Plaquenil prolongs the QT interval. Ventricular arrhythmias and torsade de pointes have been reported in patients taking Plaquenil.
Eye disorders: Irreversible retinopathy with retinal pigmentation changes (bull's eye appearance), visual field defects (paracentral scotomas) and visual disturbances (visual acuity), maculopathies (macular degeneration), decreased dark adaptation, color vision abnormalities, corneal changes (edema and opacities) including corneal deposition of drug with or without accompanying symptoms (halo around lights, photophobia, blurred vision).
General disorders and administration site conditions: Fatigue.
Hepatobiliary disorders: Liver function tests abnormal, hepatic failure acute.
Musculoskeletal and connective tissue disorders: Sensorimotor disorder, skeletal muscle myopathy or neuromyopathy leading to progressive weakness and atrophy of proximal muscle groups, depression of tendon reflexes and abnormal nerve conduction.
Skin and subcutaneous tissue disorders: Rash, pruritus, pigmentation disorders in skin and mucous membranes, hair color changes, alopecia.
Dermatitis bullous eruptions including erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS syndrome), photosensitivity, dermatitis exfoliative, acute generalized exanthematous pustulosis (AGEP).
To report suspected adverse reactions, contact Concordia Pharmaceuticals Inc. at 1- 877-370-1142 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
What drugs interact with Plaquenil (hydroxychloroquine)?
- Administration of hydroxychloroquine with penicillamine (Cuprimine, Depen) may increase penicillamine levels, increasing the risk of penicillamine side effects. The mechanism is unknown.
- Combining telbivudine (Tyzeka) and hydroxychloroquine may increase the risk of unexplained muscle pain, tenderness, or weakness because both drugs cause such side effects.
- Hydroxychloroquine suppresses the immune system and should not be combined with drugs that also suppress the immune system or live vaccines.
Concomitant Plaquenil and digoxin therapy may result in increased serum digoxin levels: serum digoxin levels should be closely monitored in patients receiving combined therapy.
Insulin Or Antidiabetic Drugs
Drugs That Prolong QT Interval And Other Arrhythmogenic Drugs
Plaquenil prolongs the QT interval and should not be administered with other drugs that have the potential to induce cardiac arrhythmias. Also, there may be an increased risk of inducing ventricular arrhythmias if Plaquenil is used concomitantly with other arrhythmogenic drugs.
Mefloquine And Other Drugs Known To Lower The Convulsive Threshold
The activity of antiepileptic drugs might be impaired if co-administered with Plaquenil.
Combined use of methotrexate with Plaquenil has not been studied and may increase the incidence of adverse effects.
An increased plasma cyclosporin level was reported when cyclosporin and Plaquenil were co-administered.
The following interactions have been observed on treatment with the structurally related substance chloroquine phosphate, and therefore cannot be ruled out for hydroxychloroquine.
Chloroquine has been reported to reduce the bioavailability of praziquantel.
Antacids And Kaolin
Antacids and kaolin can reduce absorption of chloroquine; an interval of at least 4 hours between intake of these agents and chloroquine should be observed.
Cimetidine can inhibit the metabolism of chloroquine, increasing its plasma level. Concomitant use of cimetidine should be avoided.
In a study of healthy volunteers, chloroquine significantly reduced the bioavailability of ampicillin.
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Medications & Supplements
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Professional side effects and drug interactions sections courtesy of the U.S. Food and Drug Administration. COVID-19 Drug Therapy – Potential Options
Tim Smith, PharmD, BCPS and Tony Prosser, PharmD
Clinical Drug Information - Clinical Solutions