Plaquenil (hydroxychloroquine) is a prescription medicine used to treat lupus erythematosus and rheumatoid arthritis. With coronavirus (COVID-19) outbreak all over world, it has started to be used in treatment of the coronavirus. Plaquenil has currently been used experimentally in a small number of coronavirus patients. The medicine, which became current agenda thanks to promising studies conducted especially in China and Europe, was started to be used on coronavirus patients in our country; however, its effectiveness has not been fully proven. There are ongoing studies on the effect of the medicine on the coronavirus.
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What is Plaquenil (hydroxychloroquine)?
Plaquenil is a prescription medicine widely used in the treatment of malaria, lupus erythematosus, rheumatoid arthritis, juvenile idiopathic arthritis, and some skin diseases. The medicine, whose active ingredient is hydroxychloroquine sulphate, is commercially available in tablet form.
Each tablet in the box contains 200 mg of hydroxychloroquine sulphate. Research in China promises hope that medicines with the active ingredient hydroxychloroquine and chloroquine can be effective in the treatment of the coronavirus.
Can hydroxychloroquine and chloroquine treat coronavirus?
Hydroxychloroquine (Plaquenil) or chloroquine effectiveness in the treatment of coronavirus has not yet been proven and its use has not been approved by the FDA. However, studies are ongoing. In a small-scale laboratory study conducted in China, it was identified that coronavirus patients treated with chloroquine either presented with a milder disease or stayed in the hospital shorter compared to other patients. The study recommends chloroquine treatment to all coronavirus patients.
In a small-scale study conducted in France without detailed information about its stages, it was stated that hydroxychloroquine could be used in treatment. Even though its clinical efficacy has not been proven, many doctors have started prescribing it, and it has been listed by the World Health Organization as a medicine whose efficacy is being investigated. Studies on use of hydroxychloroquine and chloroquine in COVID-19 treatment are ongoing.
What is Plaquenil used for?
Plaquenil, which is also used in the treatment of malaria in the USA and Europe, is used in the treatment of the following diseases in our country:
Dosing of Plaquenil may change based on age, condition of treatment, severity of the disease, and other medical problems a patient has. However, generally recommended doses are as follows:
Adults: In acute cases, the starting dose is 800 mg. After this first dose, 3 more doses of 400 mg are taken 6 hours, 24 hours and 48 hours later. The medicine is started 2 weeks before the exposure to malaria and a dose of 400 mg is taken once a week to prevent malaria.
Children (0-17 years): In acute cases, the starting dose is 13 mg / kg (maximum dose: 800 mg). After the first dose, 3 more doses of 6.5 mg/kg are taken 6 hours, 24 hours, and 48 hours later.
Adults: Daily doses of 200 mg – 400 mg can be taken either as a single dose or BID by dividing the dose into two.
There is no dose defined for children under 18 years old.
Rheumatoid arthritis dose
Adults: The starting dose of 400 mg – 600 mg/d can be taken as either single or BID by dividing the dose into two. As a maintenance dose, a single daily dose of 200 mg or a total daily dose of 400 mg taken by dividing into two is recommended. It can cause eye problems if taken more than 600 mg/d.
Dosage for skin problems and for juvenile idiopathic arthritis in children
Adults: 200-400 mg (1-2 tablets) daily.
Children (0-17 years): 200 mg (1 tablet) daily.
It may take several months for the medicine to take effect in rheumatoid arthritis, several weeks in other diseases.
Dose of Plaquenil in the coronavirus treatment
Doctors report different doses as the dose to be used in the coronavirus treatment has not been established yet. Therefore;
400 mg on the first day, followed by 400 mg daily for 5 days
400 mg on the first day, then continue with 200 mg for 4 days
600 mg on the first day, then 400 mg for 2-5 days.
Plaquenil may interact with other medicines, vitamins, or herbs. This may cause an increase in the side effects or a decrease in its effect. If you have a medication or take supplements, be sure to inform your doctor.
Drugs that may interact with Plaquenil (Hydroxychloroquine):
Digoxin (cardiac medication): May cause an increase in the level of digoxin in your body.
Insulin and other diabetes medications: (chlorpropamide, glipizide, glimepiride, repaglinide, etc.) Taking Plaquenil with these drugs causes hypoglycemia (low blood sugar).
Medicines affecting the cardiac rhythm (amiodarone, chlorpromazine, clarithromycin): May cause dangerous cardiac rhythm disturbance.
Some malaria medicines (mefloquine, halofantrine): May increase the risk of seizures.
Use of Plaquenil during breastfeeding and pregnancy
Some studies show that the medicine can be transferred from the mother’s bloodstream to the baby. Therefore, Plaquenil should not be used during pregnancy or if there is a plan to become pregnant. Be sure to inform you doctor if you become pregnant while taking the drug.
Furthermore, the medicine may pass into breast milk at a small amount. However, its effects on the baby are not known well. Therefore, the mother and doctor should make a decision together by considering pros and cons.
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