Quick Answers
Plaquenil (hydroxychloroquine) can cause some stomach side effects like nausea, vomiting, diarrhea, and abdominal pain. These side effects are usually mild but can sometimes be more severe. Taking Plaquenil with food may help reduce stomach issues. Stomach problems are most common when first starting Plaquenil and often improve over time. If stomach problems are severe or don’t go away, talk to your doctor about alternatives. Overall, Plaquenil is usually well-tolerated but monitoring side effects is important.
What is Plaquenil?
Plaquenil (hydroxychloroquine) is an oral medication primarily used to treat autoimmune diseases like rheumatoid arthritis and lupus. It was originally developed as an anti-malarial drug. Plaquenil works by modulating the immune system and reducing inflammation. It can help control disease activity and prevent flare-ups in many autoimmune conditions. Plaquenil is often considered a foundational treatment for diseases like rheumatoid arthritis and systemic lupus erythematosus (SLE).
Mechanism of Action
The exact mechanism of action of Plaquenil is not fully understood. However, it is believed to work in several ways:
- Reduces immune cell activation
- Decreases production of inflammatory cytokines
- Interferes with interactions between cells involved in inflammation
- Inhibits toll-like receptors involved in innate immunity
Through these effects, Plaquenil can reduce pain, swelling, stiffness, and other symptoms of autoimmune diseases. It may also help prevent damage to joints and other tissues.
What are the side effects of Plaquenil?
Like all medications, Plaquenil can cause some side effects. Some of the most common side effects involve the stomach and digestive system. Potential stomach-related side effects of Plaquenil include:
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Loss of appetite
These types of stomach issues are usually mild. Up to 10-25% of people taking Plaquenil may experience nausea or diarrhea, especially when first starting treatment. Over time, the digestive system often adjusts and side effects improve. Taking Plaquenil with food can help minimize stomach upset. If nausea or diarrhea are severe, temporary dose reductions may help.
Some other common side effects of Plaquenil include:
- Headaches
- Dizziness
- Visual changes
- Skin rash
- Hair loss
Plaquenil can also cause some rare but serious side effects involving the eyes, heart, or blood cells. These risks are generally low, but regular monitoring is important while taking this medication.
Risk Factors for Stomach Side Effects
Some people seem more prone to Plaquenil’s stomach effects than others. Risk factors include:
- Being overweight or obese
- Age over 60 years old
- Having pre-existing stomach conditions like ulcers or reflux
- Taking high doses of Plaquenil
- Using other medications that can upset the stomach
- Drinking alcohol
- Being a woman
Careful monitoring and dose adjustments can help manage side effects in high-risk groups. Switching to alternative medications is another option if Plaquenil’s gastrointestinal effects are intolerable.
How common are stomach problems with Plaquenil?
Mild stomach problems like nausea and diarrhea are fairly common with Plaquenil, especially when treatment is first started. Data indicates:
- 10-25% of patients report nausea
- Up to 20% experience diarrhea
- 5-10% have vomiting
- 5-15% develop abdominal pain
These side effect rates are highest early in treatment and often decrease over time as the body adjusts. One study found the risk of nausea and vomiting was 3 times higher in the first month of Plaquenil treatment compared to later on.
Severe gastrointestinal effects like persistent vomiting, bloody diarrhea, and intense abdominal pain are much less common, affecting less than 5% of patients. Only about 1-2% of people need to stop Plaquenil due to intolerable stomach issues.
Overall, while stomach problems are a recognized side effect of Plaquenil, they are usually mild and temporary in most people. Careful monitoring and dose adjustments can help manage gastrointestinal side effects.
Do stomach issues get better over time?
For many people, stomach issues from Plaquenil do get better over the first few months of treatment. There are a few reasons for this:
- The body adjusts to the medication over time
- Doses may be optimized to reduce side effects
- Patients learn to take Plaquenil properly to minimize issues
Studies show the highest risk of nausea, vomiting, and diarrhea is within the first 1-2 months of starting Plaquenil. Side effect rates tend to decline after this initial period. One study found nausea decreased from 11% during month one to 6% by month six of treatment.
However, some people do continue to experience persistent or intermittent stomach problems while taking Plaquenil. Around 5-10% of patients have ongoing issues like nausea and diarrhea lasting more than 6 months. For these individuals, switching medications or adding medications to treat the side effects may be beneficial.
In summary, stomach problems from Plaquenil often (but not always) improve with time. Close monitoring and follow up with your healthcare provider is important, especially early in treatment.
Tips for minimizing stomach side effects
Here are some tips to help reduce the risk of stomach problems when taking Plaquenil:
- Take with food – Plaquenil absorption is not affected by food, so take it with a meal to minimize nausea.
- Stay hydrated – Drink plenty of fluids, especially with diarrhea.
- Take at bedtime – Taking Plaquenil at bedtime may help some people if it causes drowsiness or nausea.
- Try antacids – Over-the-counter antacids can help treat symptoms of nausea, heartburn, or indigestion.
- Start at low doses – Your doctor may start at a lower dose and titrate up slowly to improve tolerance.
- Avoid triggers – Avoid spicy foods, caffeine, alcohol, and NSAIDs as they can exacerbate stomach issues.
- Report symptoms – Notify your doctor if side effects are severe or don’t improve with time.
Making lifestyle changes like eating a bland diet, losing weight, and reducing stress can also help minimize Plaquenil’s gastrointestinal effects for some people.
When should you call a doctor?
Mild and temporary stomach upset is expected with Plaquenil. However, call your doctor if you experience:
- Severe nausea/vomiting lasting more than 2 days
- Unable to keep down food/fluids due to vomiting/diarrhea
- Diarrhea persisting more than 3 days
- Bloody or black stool
- Intense abdominal pain
- Fever over 102°F (38.9°C)
- Signs of dehydration like dizziness, confusion, rapid heart rate, or fainting
- Yellowing skin or eyes (sign of liver problems)
These types of severe and persistent gastrointestinal symptoms may require stopping Plaquenil treatment, at least temporarily. Make sure to monitor side effects closely and follow up with your healthcare provider if problems arise.
How long do Plaquenil stomach problems last?
For most people, stomach issues from Plaquenil are temporary and tend to resolve within 1-2 months as the body adjusts. One study found nausea typically lasted around 5 days on average when first starting Plaquenil. Diarrhea lasted approximately 9 days on average.
However, a subset of patients do experience persistent stomach problems lasting longer than 6 months. Around 5-10% of people have ongoing gastrointestinal side effects like nausea and abdominal pain while taking Plaquenil long term. Some patients find taking antacids, probiotics, or antidiarrheal medications helpful in controlling lasting symptoms.
If bothersome stomach problems continue long term, your rheumatologist may recommend switching to a different antirheumatic medication. There are many alternatives to Plaquenil with different side effect profiles.
Overall, give Plaquenil at least 2-3 months for gastrointestinal effects to improve unless symptoms are severe. Notify your doctor about any lasting stomach issues so adjustments can be made. Be sure to report side effects at each follow up visit.
Natural and home remedies to soothe the stomach
Some natural remedies may help soothe the stomach when taking Plaquenil:
- Ginger – Ginger root or ginger tea can ease nausea and vomiting.
- Peppermint – Peppermint oil capsules may relieve upset stomach, gas, and bloating.
- Probiotics – Probiotic supplements can improve diarrhea related to antibiotics and may help with Plaquenil.
- BrAT diet – Eating low fiber, bland foods can calm GI upset. Try bananas, rice, applesauce, and toast (BRAT).
- Chamomile tea – Chamomile has anti-inflammatory properties that may decrease stomach irritation.
- Licorice root – Licorice helps coat and soothe the stomach lining and may reduce nausea.
Check with your doctor before using any herbal products, as they can have side effects and interact with medications. While some natural remedies may provide symptom relief, talk to your healthcare provider if stomach problems persist.
Can you take anything for Plaquenil stomach pain?
There are several over-the-counter and prescription medications that can help treat stomach pain and other gastrointestinal side effects from Plaquenil:
- Antacids like Tums, Rolaids, and Maalox can help neutralize stomach acid and relieve indigestion, heartburn, and abdominal discomfort.
- Anti-nausea drugs like Emetrol, Bonine, Dramamine, or promethazine may reduce feelings of nausea.
- Antidiarrheal agents like Imodium, Kaopectate, and Lomotil can help control diarrhea and cramping.
- Proton pump inhibitors like Prilosec and Nexium block acid production and can heal ulcers.
- Prokinetics like Reglan can speed stomach emptying and peristalsis to resolve nausea, reflux, bloating.
It’s best to check with your doctor before taking anything, as some drugs like Pepto-Bismol can interact with Plaquenil. Your doctor may have specific recommendations for medications to relieve your symptoms. Make sure to report all side effects at follow up visits.
Alternative medications if Plaquenil causes stomach issues
If you have persistent or severe stomach issues from Plaquenil, your rheumatologist may recommend switching to an alternative antirheumatic medication. Some options include:
- Sulfasalazine (Azulfidine) – Similar effectiveness as Plaquenil but less GI irritation.
- Leflunomide (Arava) – Immunomodulator used for RA and psoriatic arthritis.
- Methotrexate – First line DMARD with different side effect profile than Plaquenil.
- Azathioprine (Imuran) – Immunosuppressant used for rheumatoid arthritis.
- Biologic DMARDs – TNF inhibitors like Humira are used for moderate to severe rheumatoid arthritis.
Your rheumatologist can help determine the best medication for your condition based on efficacy, side effects, and other factors. Never stop taking Plaquenil without first consulting your healthcare provider.
The bottom line
Plaquenil can cause stomach-related side effects like nausea, vomiting, diarrhea, and abdominal pain, especially when treatment is first started. For many people, these gastrointestinal issues are mild and temporary. Taking Plaquenil with food, starting with lower doses, and using medications for symptom relief can help reduce stomach problems.
Severe or persistent stomach issues from Plaquenil are less common but may require stopping the medication. Notify your healthcare provider if you have lasting gastrointestinal symptoms so alternative treatment options can be explored. With proper monitoring and management, most people can tolerate Plaquenil well. But it’s important to speak up about any side effects you experience.
