Antimalarial Medicines for Lupus
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How It Works
These medicines reduce inflammation. (They are also used to prevent or treat malaria, but there is no known relationship between lupus and malaria.)
Why It Is Used
These medicines are used to control skin rash in people who have lupus. They also may help relieve muscle and joint pain, fatigue, and fever. And they may protect organs such as the kidneys.
These medicines may be used together with anti-inflammatory drugs (NSAIDs), corticosteroids, or medicines that suppress the immune system. Using them may allow you to reduce the dose of other medicines to a level that causes fewer or less bothersome side effects.
How Well It Works
A review of several studies shows that antimalarials reduce overall disease activity. They may have several other effects, including reducing disease flares and protecting organs such as the kidneys.1
Antimalarial medicine is used with corticosteroid creams to control lupus skin rash, and it has long been used to control lupus-related joint pain.2 For skin rash, this treatment works best when it is combined with protecting the skin from the sun.
Hydroxychloroquine seems to help reduce fatigue and malaise (generally not feeling well). But it can take a few months to notice this effect.3
Hydroxychloroquine may protect against lupus disease flares.2
Antimalarials are likely to help joint pain and reduce inflammation of the sac around the heart and the sac around the lungs.4
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Call 911 or other emergency services right away if you have:
- Trouble breathing.
- Swelling of your face, lips, tongue, or throat.
Call your doctor right away if you have:
- Any blurred vision, problems seeing to read, or changes in vision. Your doctor may have you check your vision at least once a month using an Amsler grid, which is a chart with lines and a dot at the center that lets you monitor changes in vision. If you notice any changes in vision or changes in your view of the Amsler grid, call your doctor.
Common side effects of this medicine include:
- Nausea or vomiting.
- Stomach cramps.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
It may take several months for these medicines to work. If antimalarial treatment doesn't seem to be helping within 6 months, your doctor may recommend that you stop taking it.
Some antimalarial medicines, such as hydroxychloroquine, can cause serious and permanent damage to the retina of the eye. When appropriate doses are given, this is rare. If it is found early, eye damage may be reversed and permanent damage may be prevented. So be sure to have an initial ophthalmic exam before you begin antimalarial therapy. Then have your eyes examined if you notice a change in vision. Your doctor may recommend visits to the ophthalmologist as often as every 3 to 12 months, depending on your vision and your doctor's level of concern about eye disease.
The dose of antimalarial medicine may be adjusted if you have kidney or liver disease.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments. And call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
- Ruiz-Irastorza G, et al. (2010). Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: A systematic review. Annals of the Rheumatic Diseases, 69(1): 20–28.
- Wofsy D (2005). Therapy of systemic lupus erythematosus. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 1561–1574. Philadelphia: Lippincott Williams and Wilkins.
- Lockshin MD (2008). Systemic lupus erythematosus. In DC Dale, DD Federman, eds., ACP Medicine, section 15, chap. 4. New York: WebMD.
- Madhok R, Wu O (2009). Systemic lupus erythematosus, search date December 2007. Online version of Clinical Evidence (7).
Last Revised: May 7, 2012
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