Has your doctor or rheumatologist told you to stop taking your hydroxychloroquine (Plaquenil) prescription, or have you been experiencing side effects that make you want to stop? If so, you might be wondering how long it stays in your system and how long it might take until your side effects become less intense.

Some MyLupusTeam members have also asked others about their experiences coming off hydroxychloroquine and how long the drug sticks around after stopping it. One member wrote, “I was told to come off Plaquenil by my doctor. My question is, how long does it stay in your body once you’re off of it? I’ve been on it for six months.”

In this article, we’ll discuss what hydroxychloroquine is, how it’s used to manage lupus, and how long it stays in your body after you stop taking it. We’ll also go over what to do if you miss a dose of hydroxychloroquine and how it can affect your condition.

What Is Hydroxychloroquine?

When you’re living with lupus, your immune system mistakes your body’s healthy tissues as foreign invaders. Your immune system creates inflammation that damages your skin, joints, and organs over time. Lupus treatments focus on reducing this inflammation to help slow disease progression and prevent lasting damage.

Hydroxychloroquine is an antimalarial drug that is also used to treat autoimmune diseases. Doctors now prescribe it to treat:

• Systemic lupus erythematosus (SLE)
• Discoid lupus erythematosus (DLE)
• Rheumatoid arthritis

Specifically, hydroxychloroquine stops your immune cells from receiving inflammatory signals, preventing them from creating more inflammation. It also lowers the amount of autoantibodies or immune system proteins that target your healthy tissues.

Hydroxychloroquine is classified as a disease-modifying antirheumatic drug (DMARD) because it treats joint pain, inflammation, and swelling associated with lupus. Research shows that hydroxychloroquine also prevents lupus flares and reduces the risk of organ damage and blood clots.

Hydroxychloroquine Dosing

It takes time for hydroxychloroquine to build up in your system and reach a steady concentration. This means it may take one to three months for the drug to become completely effective. Your doctor or rheumatologist will likely start you out on a higher dose — typically 400 milligrams (mg) per day. You’ll take this higher dose for several weeks to help build up a steady amount of hydroxychloroquine in your bloodstream.

You may still have symptoms when you first start hydroxychloroquine. However, they should gradually get better the longer you take your medication. After a while, your doctor may lower your dose to between 200 and 400 mg per day. This adjustment helps prevent unwanted side effects from developing.

Side Effects of Hydroxychloroquine

In general, hydroxychloroquine is a well-tolerated lupus treatment. When you first start taking it, you may experience common side effects like nausea, loss of appetite, stomach cramps, or vomiting. These symptoms usually go away on their own once your body gets used to the drug.

High doses of hydroxychloroquine over long periods of time can damage your retina — the light-sensitive tissue in your eye. Make sure to get your eyes checked regularly. Be sure to talk to your eye doctor if you notice any new vision problems.

How Long Does Hydroxychloroquine Stay in Your System?

According to Brigham and Women’s Hospital, hydroxychloroquine stays in your body for roughly three months. To better understand why it stays around for so long, it’s important to learn about a drug’s half-life.

The half-life of a drug refers to the length of time it takes for your body to break down half of the amount of the drug. Hydroxychloroquine’s half-life is just over 22 days. This means if you take a 200-mg dose, it takes 22 days for your body to break down 100 mg (half) of it. Then, it takes another 22 days to break down 50 mg of it, and so forth.

Because it takes time for your body to break down hydroxychloroquine, you may still experience side effects even after you stop taking it. These side effects should go away over time as your body clears out the drug.

What Happens if You Miss a Dose of Hydroxychloroquine?

While it’s important to take your hydroxychloroquine daily as prescribed by your doctor, you might miss an occasional dose. Life gets busy, and maybe you forget to pack your medication for a weekend trip or forget to have it refilled at the pharmacy. So, what happens if you miss a dose? Because hydroxychloroquine builds up in your system and takes several days to be broken down, you likely won’t notice any lupus symptoms if you miss one or two doses.

MyLupusTeam members have asked about the effects of missing one or more doses of hydroxychloroquine. One member asked, “I take two 200-mg tablets of Plaquenil per day. I’ve missed some lately due to being overtired and running around after a 3-year-old. I have some off symptoms now, and I’m wondering if they’re related to missing the tablets. What happens if you miss a dose of Plaquenil?”

Other members replied:

• “Missing a dose here or there really shouldn’t affect you that strongly. I’ve missed doses and don’t even notice.”
• “I only notice when I totally forget for a week or more. It makes me tired, slow, and achy. Other times, I don’t notice a difference. It all depends on how active your lupus is at the time.”
• “I miss all the time (oops). As long as I take it next time, I haven’t noticed any problems with missing a dose.”

If you miss your hydroxychloroquine dose, it’s recommended to wait until your next dose is due. Don’t make up a missed dose or take twice the amount for your next one. It’s important to stay on schedule to avoid taking too much. To learn more about what to do if you miss a dose or if you have any questions, talk to your doctor or rheumatologist.

Stopping Hydroxychloroquine Safely

If you’re experiencing severe side effects, your doctor may recommend completely stopping hydroxychloroquine. It’s not recommended to quit hydroxychloroquine on your own cold turkey. Instead, your doctor will help you gradually lower your dose of hydroxychloroquine over time to help your body adjust.

Stopping hydroxychloroquine may cause your lupus symptoms to flare up. One study found that people who stopped taking their medication were more likely to experience a flare compared to those who continued treatment. Common symptoms of lupus flares include:

• Rashes
• Swollen or painful joints
• Fever without an infection
• Feeling extremely fatigued
• New ulcers or sores in your mouth or nose

MyLupusTeam members have also shared their experiences stopping hydroxychloroquine. One mentioned, “In my experience, stopping hydroxychloroquine without weaning results in nausea, diarrhea, body pain (particularly in the ribs), and an increase in flares.”

“I was just told to stop after two years because of my eyes. I’ve been off for about a month and I’m really having joint problems,” wrote another.

Some members have found that stopping helps their medication side effects but may cause their lupus symptoms to return. A member shared, “One day, I missed my Plaquenil dose because I was super busy and noticed my stomach didn’t hurt at all. I decided not to take it for the next two days. My stomach problems went away, but then my chest started to hurt.”

Adjusting Other Medications

Many people who take hydroxychloroquine can take lower doses of their lupus medications. In addition to hydroxychloroquine, you might also have been prescribed an immunosuppressant drug like methotrexate (Rheumatrex) or a corticosteroid like prednisone to help reduce inflammation and treat your lupus.

Your doctor or rheumatologist will help you adjust your treatment plan accordingly. Be sure to follow their instructions and take your medications as prescribed to avoid any unwanted side effects.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 222,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Do you have more questions about your hydroxychloroquine prescription? Share them in the comments below, or start a conversation by posting on your Activities page.