Have you ever had a dream that you remembered when you woke up? If you have a vivid dream, you’ll be more likely to remember it the next day. These dreams can be joyous, strange, or disturbing. Vivid dreams have various causes, including certain medications.

Members of MyLupusTeam have discussed the possibility of hydroxychloroquine (sold under the brand name Plaquenil) causing vivid dreams. One member asked, “Does anyone have strange dreams on Plaquenil? I’ve only been on it about four months … but my dreams are so vivid.”

Hydroxychloroquine is a medication used to treat malaria and autoimmune diseases, including lupus and rheumatoid arthritis (RA). Hydroxychloroquine these conditions by altering parts of the immune system and decreasing disease flares.

Hydroxychloroquine Side Effects

The most common side effects of hydroxychloroquine are gastrointestinal (affecting the stomach and intestines), including nausea and diarrhea. These symptoms are usually short-lived. Other less common but reported side effects include skin rash, hair loss, and muscle weakness. Allergic reactions to hydroxychloroquine are possible but rate.

Vivid dreams are not a reported side effect of hydroxychloroquine. However, the medication can cause psychiatric (related to mental illness) side effects. The studies that have looked at the use of hydroxychloroquine in chronic disease found an increased risk of developing anxiety, depression, and suicidal thoughts.

Mood changes are considered serious side effects of hydroxychloroquine, so people with a history of mental illness are advised to use hydroxychloroquine cautiously. That said, available research has found that most cases were reported in people without a history of mental illness.

Depression and anxiety can be linked to vivid dreams for several reasons. People with depression may experience more rapid eye movement (REM) sleep than the general population. REM sleep is the stage of sleep when most dreams occur. Having more REM sleep increases your chance of experiencing vivid dreams.

Researchers have also found a connection between dreams and mood control. Dreams may help to process intense emotions, which are common in mood conditions like depression and anxiety.

If someone taking hydroxychloroquine is experiencing a depressed mood, anxiety, or suicidal thoughts, they should seek immediate medical advice from a rheumatologist or other health care professional. Other serious adverse effects of hydroxychloroquine include eye problems causing blurred vision and damage to the back of the eye, skin rash causing blisters, and abnormal heart rhythm.

Although hydroxychloroquine isn’t known to cause vivid dreams directly, everyone responds to medications differently. If you have new vivid dreams while taking hydroxychloroquine, let your doctor know.

Drugs That Cause Vivid Dreams

Unlike hydroxychloroquine, several other types of prescription medications are known to cause vivid dreams. The medicines that most commonly do this act on neurotransmitters — chemicals in the brain that send messages between brain cells to affect thoughts and mood. Below are some examples of medications that can affect dreams.

Blood Pressure Medications

About half of people living with systemic lupus erythematosus (SLE) — the most common form of lupus — develop hypertension (high blood pressure). Certain drugs for high blood pressure work by blocking the effects of a neurotransmitter called epinephrine. Epinephrine raises blood pressure. Some of these medications can cause nightmares and vivid dreams.

ACE inhibitors are a type of blood pressure medication that has been linked to vivid dreams. Examples include captopril, enalapril, and quinapril.

Alzheimer’s Disease Medications

The medications commonly prescribed to treat Alzheimer’s disease work by increasing the levels of a neurotransmitter called acetylcholine in the brain. Acetylcholine is responsible for activating muscles and other organs in the body.

These medications can make REM sleep last longer. As a result, people taking these medications may experience more intense dreams, including happy, vivid dreams and nightmares.

Research suggests that people with SLE are at increased risk of dementia.

Autoantibodies and inflammatory cells can damage the brain by passing through the blood-brain barrier. This damage can also lead to blood clotting and plaque build-up

Antidepressants and Antipsychotics

Drugs that affect serotonin levels in the brain can affect sleep and dreaming. Serotonin is a neurotransmitter known for its calming effect on mood. Tricyclic antidepressants, selective serotonin reuptake inhibitors, and monoamine oxidase inhibitors are the types of antidepressants most commonly associated with these effects.

Depression and the drugs used to treat it can affect dreams. People living with SLE are more likely to develop depression than the general population. Because of this dynamic, make sure to discuss the risks and benefits of taking antidepressants with a health care professional.

Drugs used to treat psychosis — a condition with severe mood changes and a disconnection from reality — may also cause vivid dreams. However, these drugs often reduce dream memory. Examples of antipsychotic drugs that affect dreams include chlorpromazine, thiothixene, and clozapine.

Antiparkinsonian Drugs

Parkinson’s disease is usually treated with drugs that affect dopamine levels. Dopamine is another neurotransmitter that influences mood. Drugs that increase dopamine levels, such as levodopa, bromocriptine, and amantadine, can sometimes cause more intense dreams.

People with lupus are at lower risk of developing Parkinson’s disease than the general population. However, more studies are needed to understand why.

Herbal Medicines

Herbal medicines, or supplements, have been used for thousands of years to treat various ailments. Some types that affect mood and thoughts and are known to affect dreaming include:

• St. John’s wort
• Valerian
• Licorice root
• Jasmine
• Lavender

The U.S. Food and Drug Administration (FDA) doesn’t regulate herbal supplements with the same rigor that it does perscription medications. Speak with your doctor before starting any supplements, especially if you’re taking other medications.

Reducing Nightmares

Although some vivid dreams can be pleasant, others can be nightmares. If you’re having distressing dreams that are affecting your sleep, discuss treatment options with your doctor. They can help figure out if you have a nightmare disorder and if you would benefit from therapy. Your doctor will also review your medications to see if one of them may be the cause.

Lifestyle changes can help reduce nightmares:

• Make a bedtime routine when you do something relaxing before bed. Read a book, take a warm bath, or meditate before bed each night.
• Talk about the dream. Talking about it may help reduce the fear around the nightmare.
• Try to go to sleep at about the same time each night.
• Avoid reading or watching content that is scary or distressing right before bed.
• Exercise during the day. Stretching before bed can help get you ready for sleep.
• Limit alcohol and caffeine. Alcohol can increase the amount of REM sleep and the risk of nightmares, while caffeine can make falling asleep difficult.
• Make your room a calming place. It should be dark, quiet, and have a comfortable temperature.

Hydroxychloroquine may cause certain problems with sleep, such as nightmares. And with nightmares, you may be unable to sleep well, leading to fatigue. If you are taking hydroxychloroquine and experiencing disturbing dreams, it is important to talk to your doctor. They may be able to recommend ways to help you manage these dreams.

Find Your Team

On MyLupusTeam, the social network for people with lupus and their loved ones, more than 223,000 members come together to ask questions, give advice, and share their stories with others who can relate to their lupus experience.

Are you or a loved one living with lupus? If you are taking hydroxychloroquine, have you experienced vivid dreams? Share your experience in the comments below, or start a conversation by posting on your Activities page.