Health Library Antimalarial Medications for LupusFrom Healthwise

Antimalarial medications are used to treat malaria and are also prescribed for lupus (systemic lupus erythematosus, or SLE) and rheumatoid arthritis.

These medications reduce inflammation. (While they are also used to prevent or treat malaria, there is no known relationship between lupus and malaria.)

These medications are used to control skin rash in people who have lupus. They also may help relieve muscle and joint pain, fatigue, and fever that are not controlled with nonsteroidal anti-inflammatory drugs (NSAIDs).

These medications may be used together with anti-inflammatory drugs or corticosteroids. Using them may allow you to reduce the dose of steroids to a level that causes fewer or less bothersome side effects.

Antimalarial medication is used with corticosteroid creams to control lupus skin rash, and it has long been used to control lupus-related joint pain.¹ For skin rash, this treatment works best when it is combined with protecting the skin from the sun.

Hydroxychloroquine may protect against lupus disease flares.¹

Most people experience no major side effects from antimalarial drugs. Infrequent side effects include:

• Dizziness.
• Rash and itching.
• Nausea.
• Vomiting.
• Diarrhea.
• Abdominal cramps.

A very rare side effect is damage to the retina of the eye. Before taking an antimalarial, you will have an eye exam by an ophthalmologist. Eye damage can be caught early by self-testing your vision every month or by seeing an ophthalmologist every year. If you have any change in vision, contact your ophthalmologist or rheumatologist immediately.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

It may take several months for these medications to work. If antimalarial treatment doesn't seem to be helping within 6 months, your doctor will probably recommend that you stop taking it.

An initial eye examination will usually be done before you start taking hydroxychloroquine (Plaquenil) or chloroquine (Aralen). After the initial eye examination, your doctor may require eye exams every 6 to 12 months. Your doctor may also ask you to check your eyesight regularly with an eye test at home (as with an Amsler grid). If there is a change in your eyesight, your doctor may reduce your dose or recommend that you stop taking the medication to prevent permanent eye damage. If antimalarial medication is effective, the dose may be tapered or taken less often to reduce the risk of permanent eye damage.

The dose of antimalarial medication may be adjusted if you have kidney or liver disease.

Talk to your doctor about this medication if you are pregnant or are considering pregnancy and have lupus.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

1. 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.

Author:	Shannon Erstad, MBA/MPH	Last Updated: May 13, 2008
Medical Review:	Adam Husney, MD - Family Medicine Anne C. Poinier, MD - Internal Medicine Stanford M. Shoor, MD - Rheumatology
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