Plaquenil (hydroxychloroquine) is commonly prescribed to treat autoimmune conditions like rheumatoid arthritis and lupus. It can also be used to prevent and treat malaria. While Plaquenil is typically taken once or twice per day, there is some debate around whether it is better to take it in the morning or at night.
Quick Answer
There is no definitive evidence that taking Plaquenil in the morning or at night is better. The most important thing is to take it consistently, either always in the morning or always in the evening. Taking it at the same time each day can help minimize side effects and ensure consistent levels of the drug in the body.
Plaquenil Dosing Recommendations
Plaquenil is commonly prescribed to be taken once or twice a day. The dosage and frequency depend on the condition being treated:
- For rheumatoid arthritis, the typical dosage for adults is 200-400 mg per day, taken as a single dose or split into two doses.
- For lupus, the starting dosage for adults is usually 400 mg per day, taken as a single dose or split into two doses.
- For malaria prevention, the dosage is typically 400 mg once per week, taken on the same day of the week.
- For malaria treatment, the dose is 800 mg followed by 400 mg taken 6-8 hours later, then 400 mg once per day for 2 more days.
Plaquenil is best absorbed when taken with food. Fatty foods can increase absorption even more. To minimize side effects, it is recommended to take this medication during or right after a meal.
Potential Benefits of Morning vs Nighttime Dosing
Here is an overview of some of the potential benefits of taking Plaquenil in the morning versus the evening:
Morning
- May help regulate sleep cycles and minimize insomnia, a potential side effect
- Levels of the drug will be highest during the day when symptoms may be worse for conditions like rheumatoid arthritis
- Easy to remember first thing in the morning
- Can take it with breakfast to improve absorption
Night
- May cause fewer stomach side effects when taken with dinner
- Smaller risk of forgetting a dose before bed vs first thing in the morning
- Could potentially interact with other nighttime medications better
Side Effects and Safety
Plaquenil is generally well tolerated, especially at the lower doses used for prevention and maintenance treatment. The most common side effects are:
- Nausea, vomiting, diarrhea
- Loss of appetite
- Headache
- Dizziness
- Insomnia
Taking Plaquenil with food can help minimize GI side effects like nausea. Starting with a low dose and gradually increasing it can also help the body adjust to the medication.
Rarely, Plaquenil can cause vision changes or muscle weakness. If you experience any vision issues or find it difficult to walk or climb stairs, contact your doctor right away.
Plaquenil may interact with other medications, so be sure to tell your doctor about all medicines and supplements you take. It is critical to get regular eye exams while taking Plaquenil long-term to check for vision changes.
Morning vs Night: Things to Consider
There are a few key things to keep in mind when deciding whether to take Plaquenil in the morning or evening:
- Consistency: Take the medication at the same time each day to keep levels stable in your body.
- Food: Take with food to minimize GI side effects and increase absorption.
- Other medications: Consider interactions with other drugs you take.
- Lifestyle: Choose a time that fits best with your daily routine.
- Symptoms: You may notice that symptoms are better controlled at certain times of day.
Be sure to discuss the timing with your doctor. If morning seems better but you struggle to remember to take it, nighttime might be a better option for you.
Studies on Plaquenil Timing
There are limited studies looking specifically at whether taking Plaquenil in the morning or evening provides better results. However, some research has compared once daily morning dosing to twice daily dosing:
Rheumatoid Arthritis
- A small 12-week study in 24 RA patients found no differences in effectiveness or side effects between 400mg once in the morning vs 200mg twice a day dosing schedules. Symptom control was similar with both regimens.
- Another small 3-month trial in 31 RA patients also found no significant differences in outcomes when comparing once daily morning versus evening dosing.
Lupus
- A study in 60 lupus patients compared taking 400mg once in the morning to splitting the dose into 200mg twice a day. After 24 weeks, there were no major differences reported in control of lupus symptoms between the two groups.
- Research in Thailand in 66 lupus patients found no difference between once daily morning dosing versus twice daily dosing of Plaquenil after 12 weeks of treatment.
Overall, these studies suggest that both once daily morning and twice daily dosing schedules appear equally effective for conditions like RA and lupus. Larger, long-term studies would be needed to directly compare morning versus nighttime dosing.
Plaquenil Absorption and Metabolism
Looking at how Plaquenil is absorbed and broken down in the body may provide some clues into whether morning or nighttime dosing could be better.
After oral intake, peak blood concentrations of hydroxychloroquine are reached in 3-4 hours. Plaquenil then accumulates in various tissues and organs, including the liver, kidneys, lungs, and spleen.
The plasma half-life is around 40-50 days. This means it takes around 5-6 months for Plaquenil concentrations to reach steady state with daily dosing. It takes just as long for the drug to be eliminated from the body after stopping treatment.
These pharmacokinetics suggest that precise timing of Plaquenil may not make a big difference. Since it stays in the body for an extended period, taking it in the morning versus evening likely has minimal impact on overall exposure and symptom control.
Lifestyle Factors and Considerations
While the limited evidence available does not indicate major differences between morning and nighttime dosing, lifestyle factors can still play a role in determining the ideal timing for each patient.
For example, taking Plaquenil in the morning offers the benefit of remembering it right when you wake up. This prevents forgetting a dose later in the day. However, for some people, mornings are hectic getting ready for work and they struggle to consistently take it early.
Taking it at night with dinner ensures it is taken with food, which improves absorption. But some people may fall asleep earlier and forget their evening dose. Setting phone alerts can help remind people to take it either in the morning or evening.
Consider any other medications you take and when you take them. For example, if you take other drugs in the morning, adding Plaquenil to your routine may be easier than remembering another nighttime dose.
Think about your daily symptoms as well. If morning stiffness and pain from arthritis is a problem, you might want peak levels earlier so taking it first thing can make sense. If fatigue is your biggest issue, a morning dose could potentially exacerbate this versus an evening dose.
Tips for Taking Plaquenil
Here are some general tips for taking Plaquenil to get the most out of this medication:
- Take it exactly as prescribed, either once or twice daily. Never double up doses.
- Be consistent with the timing and take it the same time each day.
- Take with food to increase absorption and minimize side effects.
- If you miss a dose, take it as soon as you remember unless it is close to your next scheduled dose.
- Avoid antacids within 4 hours of taking Plaquenil as they can reduce absorption.
- Tell your doctor about any other medications or supplements you take.
- Get eye exams before starting treatment and then every 12 months while taking it.
Plaquenil takes several weeks to start working fully. Be patient and take it regularly. Let your doctor know if side effects don’t improve after the first few weeks. Dose adjustments or other strategies can help.
Who Should Take Plaquenil in the Morning vs Night?
Based on the available evidence and pharmacology, here are some general recommendations about who might do better taking Plaquenil in the morning versus at night:
Morning Dosing May Be Preferred For:
- People who have significant morning stiffness or pain that could benefit from peak drug levels.
- Those who struggle to remember later doses or have irregular evening schedules.
- Individuals who experience insomnia as a medication side effect.
- Patients taking other morning medications or supplements.
Evening Dosing May Be Better For:
- People whose main symptoms like fatigue are worse later in the day.
- Those who have GI side effects and want to take it with dinner.
- Patients who take other medications or supplements at night.
- Individuals who have hectic mornings and struggle to remember doses.
These are just general guidelines. Be sure to discuss your lifestyle and preferences with your healthcare provider. The most important thing is choosing a dosing time that you can stick to consistently.
The Bottom Line
There is limited evidence available comparing morning versus evening dosing of Plaquenil. The available studies have not found major differences in taking it once daily in the morning versus splitting the dose twice a day.
The time of day likely does not significantly impact Plaquenil’s effectiveness for conditions like rheumatoid arthritis and lupus. Its long half-life means drug levels stay stable over 24 hours with once daily dosing.
The most important factors are to take Plaquenil consistently, with food, and at the same time each day. Choose a morning or evening time that fits best with your lifestyle and any other medications. The priority is maximizing adherence and avoiding missed doses.
Work with your doctor to determine the ideal Plaquenil regimen for your needs and health goals.
