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Plaquenil

Plaquenil

Plaquenil is an antimalarial drug that contains the active ingredient hydroxychloroquine, which is a type of medicine called a disease-modifying anti-rheumatic drug (DMARD). DMARDs are used to slow the progression of rheumatoid arthritis. Hydroxychloroquine reduces the inflammation in the joints and skin. It is also used for the prevention and treatment of certain types of malaria.

​Plaquenil reduces inflammation in the joints and skin. It also kills certain bacteria and parasites, such as the malaria parasite. Plaquenil is suitable for adults and children weighing 35 kg or more.

What is Plaquenil?

Plaquenil is an antimalarial drug that contains the active ingredient hydroxychloroquine, which is a type of medicine called a disease-modifying anti-rheumatic drug (DMARD). DMARDs are used to slow the progression of rheumatoid arthritis. Hydroxychloroquine reduces the inflammation in the joints and skin. It is also used for the prevention and treatment of certain types of malaria.

When is Plaquenil used? 

Plaquenil is primarily prescribed to treat the following conditions. 

  • Rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. The main symptoms of rheumatoid arthritis are pain, swelling and stiffness in the wrists, knees, hands or ankles. Plaquenil reduces inflammation in the joints and the associated swelling and pain.  

  • Juvenile idiopathic arthritis. This is the most common type of arthritis in children under the age of 16. Like rheumatoid arthritis it causes joint inflammation and stiffness in, for example, the hands, wrists or ankles. Children may also experience symptoms such as fatigue, eye infection and fever. The oligoarticular form of juvenile idiopathic arthritis affects four or fewer joints and can start in children from the age of two. Other forms of juvenile idiopathic arthritis appear in children between the ages of 6 and 12. Plaquenil reduces inflammation which in turn can relieve pain. 

  • Malaria. Malaria is a tropical disease caused by a parasite and spreads to humans through the bites of infected mosquitoes. The malaria parasite multiplies in the liver and then invades red blood cells. After a while, symptoms appear such as high fever and flu-like illness, including shaking chills, headache, muscle aches and tiredness. Plaquenil kills the malaria parasite. If you are taking Plaquenil for the prevention of malaria and are bitten by an infected mosquito, the parasite is killed directly, thereby preventing malaria disease. Plaquenil can also be used to treat malaria.  

  • Q fever. Q fever is a bacterial infection you can catch from infected farm animals such as sheep and goats. Q fever can cause flu-like symptoms such as headache, muscle ache, fever and coughing. Symptoms of Q fever are usually harmless and clear up without treatment. In some people it can cause serious or chronic problems and complications, such as pneumonia, hepatitis or joint problems. Plaquenil kills the bacteria that cause Q fever. Treatment of Q fever often consists of a combination of the antibiotic medicine doxycycline plus hydroxychloroquine (Plaquenil). 

  • Lupus erythematosus (LE). LE is a long-term autoimmune disease in which the body’s immune system attacks normal, healthy tissue. Symptoms include skin inflammation and, in some people, damage to the joints and/or organs. LE often manifests itself in flares, causing flu-like symptoms such as fever, muscle ache and joint pain. Many people with lupus experience skin problems, such as rashes and/or red patches in the face. Plaquenil helps ease LE symptoms. 

How is Plaquenil used? 

The general instructions for use of this medicine are as follows.

  • Plaquenil tablets should be taken with or after food.  

  • Is this medicine used to treat Q fever or malaria? Then always complete the entire course. 

  • It can take some time before the beneficial effect of this medicine on the joints is noticed. 

  • If you have forgotten to take a dose of Plaquenil, you may take it as soon as you remember, unless it is almost time for your next scheduled dose. Never take a double dose to make up for the forgotten one. 

What doses are available? 

One tablet Plaquenil contains 200 mg hydroxychloroquine. The dose prescribed will vary from person to person depending on the condition being treated. Length of treatment and daily dose must be determined by a doctor. The general recommended dose for the following conditions is listed below. 

  • Prevention of malaria. Adults: 400 mg once a week on the same day of each week. Children weighing 35 kg or more: 6.5 mg per kg of body weight, with a maximum of 400 mg (taken once a week). You should start taking the medicine one week before entering the malarial area. You should continue the tablets throughout your stay and for four to eight weeks after leaving the area. 

  • Rheumatoid arthritis. Adults: 400 mg a day. After several months of use, the starting dose may be switched to a maintenance dose of 200 mg a day. 

  • Juvenile idiopathic arthritis. Children: dosage varies per person and is determined by a doctor based on body weight. The maximum dosage in children with an ideal body weight (IBW) of 31 kg is 6.5 mg per day per kg of body weight. 

  • Lupus erythematosus. Adults: 400-600 mg a day. After some time, the starting dose may be reduced to a maintenance dose of 200-400 mg a day. 

For conditions other than those listed above, the doctor may prescribe a different dosage. Always follow the directions given by your doctor and never change the dosage without first asking for advice. For more information and precise dosage instructions, see the package leaflet. 

What are the side effects of Plaquenil?

The side effects that are known to be associated with this medicine include:  

  • Loss of appetite.  

  • Gastrointestinal symptoms such as nausea, vomiting, stomach pain and diarrhoea. 

  • Skin rash. 

  • Headache. 

  • Dizziness. 

  • Eye problems. Due to the possibility of eye damage associated with long-term use of this medicine, regular eye screening is very important. 

For a complete list of side effects, see the package leaflet. Consult a doctor or pharmacist if these or other side effects are severe or persistent. 

When not to use Plaquenil? 

Plaquenil is not suitable for everyone and should not be used if:

  • You are allergic to hydroxychloroquine or any other ingredient in this medicine.  

  • You have a pre-existing abnormality of the macula (maculopathy) or an eye condition called retinitis pigmentosa.  

  • You have a muscle condition called myasthenia gravis. 

  • You weigh less than 35 kg. 

  • If you are pregnant or breastfeeding, consult a doctor before using Plaquenil. 

There are warnings associated with this medicine for people with diabetes, certain hereditary heart conditions or impaired liver or renal function. This medicine should be used with caution in these patients and their use should be monitored closely by a doctor. For a complete list of warnings, see the package leaflet. 

Can Plaquenil be used in combination with other medicines? 

Plaquenil may interact with some medicines. This can affect how Plaquenil or other medicines work or cause unwanted side effects. Medicines known to interact with Plaquenil include: 

  • Digoxin and certain antiarrhythmic medicines (heart medication). 

  • Antidepressants belonging to the family of MAO inhibitors, certain antipsychotic medicines and tricyclic antidepressants.  

  • Other antimalarial medicines, such as halofantrine and mefloquine. 

If you are using one of the above-listed medicines, check with your doctor or pharmacist before you start treatment with Plaquenil to make sure that the combination is safe. For more information on interactions, see the package leaflet. 

Where can I buy Plaquenil? 

Plaquenil is available at pharmacies or online pharmacies. 

Can I buy Plaquenil without a prescription? 

Plaquenil is a prescription-only medicine. This means you need a prescription from a registered doctor to buy this medicine. 

References

College ter Beoordeling van Geneesmiddelen. (n.d.). Plaquenil 200 mg, filmomhulde tabletten – Geneesmiddeleninformatiebank – ARXX (Plaquenil 200 mg, film-coated tablets). Consulted on 16 March 2020 on https://www.geneesmiddeleninformatiebank.nl/ords/f?p=111:3::SEARCH:NO::P0_DOMAIN,P0_LANG,P3_RVG1:H,NL,00853

KNMP. (n.d.). Hydroxychloroquine – Apotheek.nl. Consulted on 16 March 2020 on https://www.apotheek.nl/medicijnen/hydroxychloroquine  

Radboudumc. (n.d.). Hydroxychloroquine (Plaquenil®) bij reumatische aandoeningen (Hydroxychloroquine (Plaquenil®) for rheumatic conditions). Consulted on 16 March 2020 on https://www.radboudumc.nl/patientenzorg/behandelingen/hydroxychloroquine-plaquenil-bij-reumatische-aandoeningen  

ReumaNederland. (n.d.). Reumatoïde artritis (RA) (Rheumatoid arthritis (RA)). Consulted on 16 March 2020 on https://reumanederland.nl/reuma/vormen-van-reuma/reumatoide-artritis-ra/  

Sint Maartenskliniek. (n.d.). Jeugdreuma (Juvenile idiopathic arthritis). Consulted on 16 March 2020 on https://www.maartenskliniek.nl/kinderzorg/kinderreumatologie/jeugdreuma  

Zorginstituut Nederland. (n.d.). Hydroxychloroquine – FarmacotherapeutischKompas. Consulted on 16 March 2020 on https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/h/hydroxychloroquine#samenstelling