Hydroxychloroquine and Antimalarials for Lupus

Medically Reviewed by Sabrina Felson, MD on March 04, 2024
5 min read

Most people with lupus take an antimalarial drug to control their symptoms. These drugs may also prevent blood clots and damage to your organs from lupus. Antimalarials are mostly safe to use and don’t have many side effects. While the treatment for lupus is highly individualized, hydroxychloroquine (Plaquenil) is recommended for everyone.

Hydroxychloroquine is the antimalarial drug, but other antimalarials are rarely used these days and may cause more side effects.

Many people with lupus take hydroxychloroquine for the rest of their lives to control their disease and reduce flares by as much as half.

Antimalarials are drugs originally developed during World War II to prevent or treat malaria. Doctors later found out that these drugs also treated lupus symptoms.

How do they work? Lupus is an autoimmune disease. Your immune system triggers inflammation that attacks healthy tissues and organs by mistake.

Hydroxychloroquine and other antimalarials calm your overactive immune system. They reduce lupus inflammation flares, treat symptoms, and may help prevent blood clots and organ damage. They may also lower your dose of other lupus medicines you need to take.

Antimalarial drugs reduce many lupus symptoms:

  • Mouth sores
  • Joint pain and swelling
  • Hair loss
  • Fatigue
  • Muscle pain
  • Skin rashes
  • Fevers
  • Pericarditis (inflamed tissue lining your heart)
  • Pleuritis (inflamed tissue lining your lungs)

Antimalarials help prevent lupus inflammation from spreading to your brain or spinal cord. They can prevent joint damage from lupus too.

People with lupus who take hydroxychloroquine can have lower blood cholesterol and blood sugar. This benefit is especially important if you also take steroids for lupus.

About 50% of people with lupus have antiphospholipid antibodies that raise the risk of blood clots. If you have these antibodies, hydroxychloroquine may be able to lower your risk of blood clots that can cause strokes or heart attacks.

Hydroxychloroquine can even help you live longer with lupus than you would if you didn’t take it. Before antimalarials were used to treat lupus, people sometimes died at a younger age than average.

Hydroxychloroquine is taken by mouth as a pill or tablet that you take once or twice a day. The typical dose for adults with lupus is between 200 mg and 400 mg per day. Your dose is based on your body weight. Antimalarials may also be available as liquids.

Some people with lupus start with 400 mg of hydroxychloroquine once a day for a few weeks. Once the medicine builds up in your system, your doctor may reduce your dose to 200 mg a day.

Take your hydroxychloroquine pill with food or milk to prevent stomach upset.

If you forget to take your pill, don’t double your next dose. Take your usual dose the next time.

Yes, you can take hydroxychloroquine with other drugs your doctor prescribes for lupus symptoms, including steroids like prednisone, nonsteroidal anti-inflammatory drugs (NSAIDs), immunosuppressants, or cytotoxic drugs.

Your lupus symptoms should start to improve within 1 to 3 months after you start hydroxychloroquine. It takes about 6 months to feel the full benefits.

After a few months on hydroxychloroquine, your doctor will examine you and see how well it’s working to control symptoms like joint swelling and pain. If you still have daily pain, they may try another treatment.

About 90% of people with lupus who take hydroxychloroquine don’t have any side effects.

Some people have belly pain, nausea, diarrhea, or black spots in their vision when they first take the drug. Tell your doctor right away if you have any changes in your vision. Once your body gets used to hydroxychloroquine, most GI side effects should go away. Let your doctor know if you still have side effects, and they may lower your antimalarial dose.

Hydroxychloroquine can make your skin and eyes more sensitive to sunlight, so wear UV-blocking sunglasses, long sleeves or pants, and hats when you’re in the sun. Wear sunscreen of 30 SPF or higher when you plan to be outdoors.

Other possible side effects:

  • Dry skin or rashes
  • Green or yellow skin tone
  • Appetite loss
  • Bloating

Rarer side effects include:

  • Headaches
  • Muscle aches and weakness
  • Nervousness
  • Dizziness
  • Worsening psoriasis if you have this condition

Don’t lower the dose of your hydroxychloroquine on your own if you have side effects. Talk to your doctor. They may lower your dose if needed.

Very rarely, antimalarials could cause confusion or seizures. If this happens, get medical care right away.

Other very rare side effects of hydroxychloroquine:

Call your doctor right away if you start to feel dizzy or have any palpitations.

Rarely, some people with lupus who take an antimalarial for a long time or take high doses of the drug develop damage to the retina, the tissue inside your eyes that’s sensitive to light.

Hydroxychloroquine eye damage can often be reversed.

Before you start hydroxychloroquine, get your eyes checked by an ophthalmologist, an eye specialist. Have an eye exam once or twice a year to check for damage and to make sure your eyes are healthy while you take this medication.

Your eye doctor can also give you an eye test you can do at home called an Amsler grid to check your vision between exams while you take hydroxychloroquine.

If hydroxychloroquine causes eye damage, you may need to stop taking it and switch to another lupus treatment.

People with eye diseases like macular degeneration or retinal dystrophy may be more at risk for eye damage from hydroxychloroquine.

Hydroxychloroquine and other antimalarials are safe for you to take during pregnancy and won’t harm your fetus.

If you plan to get pregnant or find out that you’re pregnant while you’re taking an antimalarial, let your doctor know.

Hydroxychloroquine isn’t only safe to take during pregnancy, it may also prevent stillbirths, premature births, and miscarriages in women with lupus. That’s because the drug calms your immune system and prevents damage to blood vessels that may be harmful during your pregnancy.

Hydroxychloroquine may interact with these drugs to cause heart rhythm problems:

Hydroxychloroquine may also interact with:

Hydroxychloroquine could increase the amount of cyclosporine (Neoral, Restasis, Sandimmune,) or digoxin (Digox, Lanoxin) in your blood if taken together.

Don’t smoke while you’re taking hydroxychloroquine. Smoking makes your antimalarial less effective and can worsen your risk of heart disease, which is already higher in lupus.

It’s safe to take vaccines that your doctor recommends while on hydroxychloroquine.

It’s safe to take antimalarials for years. Don’t stop taking your drug on your own for any reason. If you do, your lupus can flare.