Hydroxychloroquine

Antimalarial·Musculoskeletal & Rheumatology

SLE, Rheumatoid Arthritis, Malaria

Authority requiredPBSDMARDPlaquenil200 mg tablet+2

Max Dose

400 mg/day

Half-life

40-50 DAYS

Retinopathy

CRITICAL

Pregnancy

SAFE

Rapid Summary

Overview

Antimalarial agent with potent immunomodulatory effects. The foundational, life-saving baseline drug for Systemic Lupus Erythematosus (SLE).

Maximum Dose

Max 400 mg/day (strictly weight-based: max 5 mg/kg of actual body weight).

Clinical Focus

Chronic use causes irreversible retinal toxicity. Annual optometry reviews are legally/clinically mandatory.

Bottom Line

Hydroxychloroquine is a well-tolerated DMARD essential in SLE and useful in RA, but requires baseline and annual eye screening for irreversible retinal toxicity.

Formulation & Access

Brand Names

Plaquenil

Oral Routes

Tablets (200 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

SLE, Rheumatoid Arthritis, Malaria.

Clinical Place

The only drug proven to improve overall survival and prevent organ damage in SLE. Mild DMARD for RA.

Quick reference

Class & Role

Antimalarial — Antimalarial agent with potent immunomodulatory effects.

Route / Formulation

Tablets (200 mg). (Plaquenil)

Usual Dose & Max

PO 200-400 mg OD (or divided BD with food). Max 5 mg/kg/day to prevent retinal damage.

Best Uses

Hydroxychloroquine is a well-tolerated DMARD essential in SLE and useful in RA, but requires baseline and annual eye screening for irreversible retinal toxicity.

Avoid / Cautions

Pre-existing maculopathy. Pregnancy Category D (historically), but modern rheumatology guidelines mandate continuing HCQ during pregnancy for SLE, as a flare is much more dangerous to the fetus.

Key Risks

Ocular: 'Bulls-eye' maculopathy/retinopathy. Bilateral, irreversible blindness. Risk skyrockets after 5 years of use or cumulative doses > 1000g. Cardiovascular: QTc prolongation, rare cardiomyopathy. Gastrointestinal: Nausea, abdominal cramps (take with milk/food). Dermatological: Hyperpigmentation (blue-black skin staining).

Key Interactions

Other QTc prolonging drugs (e.g., Amiodarone, Macrolides). Antacids reduce absorption (separate by 4 hours).

Monitoring

Baseline complete ophthalmology exam (OCT and visual fields) within 6 months of starting, then annually after 5 years of use. Routine FBC and U&E.

Clinical Pearl

Retinal toxicity is directly tied to overdosing. A 50 kg woman taking 400 mg/day is receiving 8 mg/kg/day (way over the 5 mg/kg limit) and will go blind. Calculate doses strictly on actual body weight.

Access

Authority requiredPlaquenil200 mg tablet

Brand: Plaquenil
PBS status: Authority required
Formulation: Tablets (200 mg)

Hydroxychloroquine

Antimalarial·Musculoskeletal & Rheumatology

SLE, Rheumatoid Arthritis, Malaria

Authority requiredPBSDMARDPlaquenil200 mg tablet+2

Max Dose

400 mg/day

Half-life

40-50 DAYS

Retinopathy

CRITICAL

Pregnancy

SAFE

Rapid Summary

Overview

Antimalarial agent with potent immunomodulatory effects. The foundational, life-saving baseline drug for Systemic Lupus Erythematosus (SLE).

Maximum Dose

Max 400 mg/day (strictly weight-based: max 5 mg/kg of actual body weight).

Clinical Focus

Chronic use causes irreversible retinal toxicity. Annual optometry reviews are legally/clinically mandatory.

Bottom Line

Hydroxychloroquine is a well-tolerated DMARD essential in SLE and useful in RA, but requires baseline and annual eye screening for irreversible retinal toxicity.

Formulation & Access

Brand Names

Plaquenil

Oral Routes

Tablets (200 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

SLE, Rheumatoid Arthritis, Malaria.

Clinical Place

The only drug proven to improve overall survival and prevent organ damage in SLE. Mild DMARD for RA.

Quick reference

Class & Role

Antimalarial — Antimalarial agent with potent immunomodulatory effects.

Route / Formulation

Tablets (200 mg). (Plaquenil)

Usual Dose & Max

PO 200-400 mg OD (or divided BD with food). Max 5 mg/kg/day to prevent retinal damage.

Best Uses

Hydroxychloroquine is a well-tolerated DMARD essential in SLE and useful in RA, but requires baseline and annual eye screening for irreversible retinal toxicity.

Avoid / Cautions

Pre-existing maculopathy. Pregnancy Category D (historically), but modern rheumatology guidelines mandate continuing HCQ during pregnancy for SLE, as a flare is much more dangerous to the fetus.

Key Risks

Key Interactions

Other QTc prolonging drugs (e.g., Amiodarone, Macrolides). Antacids reduce absorption (separate by 4 hours).

Monitoring

Baseline complete ophthalmology exam (OCT and visual fields) within 6 months of starting, then annually after 5 years of use. Routine FBC and U&E.

Clinical Pearl

Access

Authority requiredPlaquenil200 mg tablet

Brand: Plaquenil
PBS status: Authority required
Formulation: Tablets (200 mg)