Hydroxychloroquine

In Aotearoa New Zealand hydroxychloroquine is available as tablets (200 mg).

• Rheumatoid arthritis or lupus: Your healthcare provider may start you on a higher dose (2 to 4 tablets daily) and reduce it after a few weeks. The usual dose of hydroxychloroquine is 1 or 2 tablets daily, although your dose may differ from this. 
• Malaria: The dose of hydroxychloroquine for malaria is different. Your prescriber will advise you on how much to take.
• Always take your hydroxychloroquine exactly as your healthcare provider has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions.

• Timing: Take hydroxychloroquine at the same time each day, with a full glass of water or a glass of milk (to help reduce nausea or feeling sick). It's best to take hydroxychloroquine with or after food, but don't take it with antacids (medicines for heartburn).
• Missed dose: If you forget to take your dose, take it as soon as you remember. But if it's nearly time for your next dose, just take the next dose at the right time. Don't take double the dose.
• Keep taking hydroxychloroquine every day: It may take up to a few months before you experience the full benefits of hydroxychloroquine.

Here are some things to know when you're taking hydroxychloroquine. Other things may be important as well, so ask your healthcare provider what you should know about.

Tests and monitoring

Blood tests: While you're taking hydroxychloroquine, you will need regular blood tests to monitor for side effects and to check whether the treatment is working. Blood tests are very important during the first few months of treatment. Over time, these tests are needed less often.

Eye tests: Hydroxychloroquine can affect your eyesight. Blurred vision may occur in the first few weeks after starting it and usually returns to normal with time. However, taking hydroxychloroquine over a long time (more than 5 years) or taking it at higher doses can cause damage to your eyes. You will need an eye test in your first year of treatment, and another one after 5 years (unless your doctor decides you need one sooner). After 5 years of treatment, you will need to have an eye test every year. After 10 years of taking hydroxychloroquine, you will need to have specialised eye testing to measure the electrical activity of your eyes. You may need to go to a hospital for this.

Vaccinations

Hydroxychloroquine makes your immune system weaker, putting you at increased risk of infections. Vaccines are a good way to prevent some infections. You should have all the vaccinations you need before you start treatment with hydroxychloroquine, because some vaccines shouldn't be taken while you're taking it. Always check with your doctor or pharmacist first. It's safe for you to have the annual flu vaccine. Keep your flu vaccinations up to date to reduce your risk of getting the flu.

Taking other medicines

Hydroxychloroquine may interact with a few medicines and herbal supplements, so check with your doctor or pharmacist before starting hydroxychloroquine or before starting any new medicines, including those you may buy over the counter. Do not take antacids for at least 4 hours before or after taking hydroxychloroquine.

Sun protection

Hydroxychloroquine makes your skin more sensitive to the sun. Protect your skin when you're in the sun, especially between 10am and 3pm. Wear protective clothing and use a high factor sunscreen (SPF 30+) when you're outside.

Pregnant or planning a pregnancy

You should avoid becoming pregnant while you're taking hydroxychloroquine. Talk to your healthcare provider about which types of contraception are suitable for you both.

Like all medicines, hydroxychloroquine can cause side effects, although not everyone gets them. If you're concerned about any symptoms, talk to your healthcare provider. The following information offers some guidance but doesn't include all possible side effects. Also read more about what to expect when starting hydroxychloroquine(external link).

Common side effects

Tell your healthcare provider if they bother you.

• Nausea (feeling sick), vomiting (being sick), stomach upset: Take hydroxychloroquine with food or a glass of milk.
• Dizziness: Sit down for a while until the feeling of dizziness passes.
• Headache.
• Muscle weakness, cramps, stiffness or tingling.
• Ringing in your ears.
  
  

Problems with your eyesight

Hydroxychloroquine can affect your eyesight. Blurred vision may occur in the first few weeks after starting it. This usually returns to normal even when you continue taking the tablets. Talk to your doctor if you are worried.

• Taking hydroxychloroquine over a long time (more than 5 years) or taking it at higher doses can cause damage to your eyes.
• You will need an eye test in your first year of treatment, and another one after 5 years (unless your doctor decides you need one sooner).
• After 5 years of treatment, you will need to have an eye test every year. 
• After 10 years of taking hydroxychloroquine, you will need to have specialised eye testing to measure the electrical activity of your eyes. You may need to go to a hospital for this.
• If you notice any changes in your eyesight, such as sensitivity to light, blurred vision, seeing light flashes, streaks or black spots, tell your doctor as soon as possible.
• It's important to wear sunglasses when you're in bright sunlight to protect your eyes.

Tell your healthcare provider immediately or phone Healthline free on 0800 611 116 if these occur

• Changes in mood or behaviour, hallucinations, anxiousness or agitation, confusion, or suicidal thoughts.
• Signs of problems with your eyes such as changes in your eyesight, sensitivity to light, blurred vision, seeing light flashes, streaks or black spots.
  
  

Phone 111 for an ambulance or go to your nearest accident and emergency (A&E) clinic if these occur

• Signs of an allergic reaction such as itchy skin, and rash, swollen lips or tongue, problems breathing, like a tight chest or shortness of breath.

Read more about medicines and side effects and reporting a reaction you think might be a side effect.