Why does Plaquenil cause weight gain?

Plaquenil (hydroxychloroquine) is a medication commonly used to treat autoimmune conditions like rheumatoid arthritis and lupus. It helps reduce inflammation, pain and swelling in the joints. One of the more common side effects of Plaquenil is weight gain. Many patients report putting on extra pounds after starting this medication. There are several reasons why Plaquenil may lead to weight gain.

Increased appetite

One of the main ways Plaquenil causes weight gain is by increasing appetite. The medication seems to stimulate hunger signals in the brain, leading people to eat more throughout the day. Studies show that patients taking Plaquenil consume more calories than they did prior to starting the drug. Overeating on a regular basis inevitably causes weight gain over time. The increased appetite is a direct side effect of the medication itself.

Water retention

Plaquenil acts as a mild diuretic, meaning it can make the body hold onto more water. This leads to swelling and fluid retention, particularly in the hands, feet and ankles. The extra water weight shows up as a few extra pounds on the scale. The water retention tends to be more pronounced when first starting Plaquenil but then subsides as the body adjusts to the medication. However, the initial weight gain can be discouraging for many patients.

Fatigue and reduced activity

Plaquenil often causes fatigue, dizziness and weakness as side effects. Patients taking this medication may notice they feel tired more often and lack the energy to exercise or be active. The fatigue means they are less likely to burn calories through physical activity. Being less active inevitably leads to weight gain over time. Even daily chores can become tiring, so patients tend to move less in general. The overall reduction in activity makes it easier to put on extra weight.

Muscle loss

Long-term use of Plaquenil may cause slight muscle wasting or loss of muscle mass. This leads to a higher ratio of body fat compared to lean muscle. Muscle helps burn more calories at rest, so losing muscle means the body requires fewer calories to maintain its weight. Without adjusting food intake, patients can start putting on extra fat more readily. The muscle loss is gradual over months and years but contributes to weight gain.

Slowed metabolism

There is some evidence that Plaquenil may slow the resting metabolic rate. This means the body burns slightly fewer calories at rest. A slower metabolism makes it easier to gain weight with the same diet and activity level as before. However, the degree to which Plaquenil slows metabolism is thought to be relatively small. But in combination with increased appetite and fatigue, even a slight drop in metabolic rate can lead to extra weight.

Emotional eating

Some patients dealing with autoimmune symptoms like joint pain and fatigue turn to food for comfort. The emotional distress of chronic illness often leads to stress eating and craving indulgent foods. Plaquenil may improve autoimmune symptoms but does not address the emotional components and food cravings. Patients may continue overeating as a coping mechanism, especially if they don’t have adequate psychological support.

Digestive changes

Plaquenil can cause digestive issues like diarrhea, nausea, vomiting and stomach pain. Some patients notice more gas, bloating or changes in their bowel habits after starting the medication. The digestive changes can affect nutrient absorption and metabolism. Even a small difference in how food is broken down and absorbed can ultimately impact weight over the long run.

Effects on hormones

There is some indication that Plaquenil may influence certain hormone levels. Some studies show it may lower testosterone levels in men. Lower testosterone is linked to increased body fat. The medication may also affect thyroid hormone, as some patients report symptoms of hypothyroidism like fatigue, weight gain and feeling cold. More research is needed to confirm the effects on hormones. But hormonal fluctuations likely contribute in some patients.

Risk factors for weight gain on Plaquenil

Certain factors seem to increase the risk of gaining weight on Plaquenil:

  • Taking higher dosages – the risk seems higher with doses above 400mg per day
  • Long-term use – weight gain seems more likely after using it for years
  • Advanced age – older patients may be more affected
  • Female gender – women appear more susceptible to weight gain
  • Pre-existing overweight – those already overweight tend to gain more
  • Sedentary lifestyle – inactivity worsens the effects
  • High-calorie diet – overeating exacerbates the weight gain
  • Slow metabolism – those with naturally slow metabolism may gain more

Patients with these risk factors may need to be particularly vigilant about controlling their weight with diet and exercise while on Plaquenil.

Tips to prevent weight gain on Plaquenil

To help minimize excess weight gain while on Plaquenil, consider these diet and lifestyle strategies:

Control portions

Be mindful of portion sizes to account for increased appetite. Measure portions and use smaller plates to avoid overeating. Fill up on low-calorie foods like fruits and vegetables. Try to minimize empty calorie foods. Making dietary changes to offset the hunger effect can help tremendously.

Stay active

Make an effort to continue exercising and moving regularly despite fatigue. Even light activity like walking helps burn extra calories. Look for gentle exercises like yoga, swimming and cycling that put minimal strain on the joints. Staying active counters the drop in calorie expenditure from reduced muscle mass and slower metabolism.

Manage fluid intake

Drink plenty of water daily and limit sodium consumption to control fluid retention. Avoid excessive carbohydrates which can worsen water retention. Supplements like dandelion or potassium may help reduce fluid accumulation as well. Wearing compression stockings can also minimize water weight gain.

Get enough sleep

Prioritize sleep to help control hunger hormones and reduce fatigue. Being well-rested gives you the energy for physical activity as well. Aim for 7-8 hours of quality sleep per night. Having good sleep hygiene helps manage your weight.

Reduce processed foods

Eat more whole, unprocessed foods. Minimize simple sugars, refined carbohydrates, fried foods and trans fats. Focus your diet on lean proteins, fruits, vegetables, whole grains, nuts and healthy fats. Eating more fiber helps control hunger and feed the healthy gut microbiome.

Manage stress

Find healthy ways to manage stress levels rather than emotional eating. Things like yoga, meditation, journaling and talking to friends can help relieve anxiety. Seek counseling if needed to develop better coping skills. Managing stress prevents comfort eating.

Be patient

It can take some time to adjust the diet, activity level and lifestyle to better control your weight on Plaquenil. Monitor your weight regularly and make incremental changes as needed. Be patient and persistent with healthy lifestyle changes.

Medications that may worsen weight gain

Some medications used alongside Plaquenil can potentially exacerbate weight gain. These include:

  • Corticosteroids like prednisone – increased appetite and fluid retention
  • Anti-seizure drugs like gabapentin – can slow metabolism
  • Antidepressants – increased appetite and carbohydrate cravings
  • Insulin and sulfonylureas – increase hunger signals
  • Antihistamines – increased appetite
  • Beta-blockers – fatigue and reduced activity
  • Antipsychotics – metabolic dysfunction

Being aware of the additive side effects of other medications allows patients to monitor their weight more closely and take preventative steps.

Lifestyle changes to lose weight on Plaquenil

If you’ve already gained weight on Plaquenil, you can take steps to lose the extra pounds with targeted diet and lifestyle changes:

Try intermittent fasting

Fasting techniques help control calorie intake and hunger hormones. Try fasting 14-16 hours overnight, limiting eating to an 8-10 hour daily window. This helps with portion control.

Lower glycemic index diet

Focus on low glycemic foods that stabilize blood sugar and insulin levels rather than causing spikes and crashes. This helps manage appetite.

Increase protein intake

Eat high protein foods like eggs, lean meats, nuts and beans to improve satiety. Protein requires more energy to metabolize as well.

Reduce carbohydrates

Minimize refined carbohydrates from breads, pastas, cereals, etc. Follow a low-carb or ketogenic diet to promote fat burning.

Add yoga and pilates

Try yoga and pilates which build lean muscle mass and improve flexibility. The stretching and gentle movements suit sore joints.

Walk daily

Aim for 10,000 steps per day or at least 30 minutes of walking to keep active without over-exertion. Walking is excellent for weight loss.

Lift weights

Incorporate light strength training 2-3 times a week to maintain muscle mass. Use small hand weights or resistance bands suited for your fitness level. More muscle helps burn calories.

See a nutritionist

Consult a nutritionist who can tailor a diet plan to help you lose weight while accounting for your medications and health conditions. Professional guidance is invaluable.

Consider supplements

Supplements like conjugated linoleic acid, glucomannan and green tea extract may support weight loss through various mechanisms. Discuss suitable options with your doctor.

When to see your doctor

Consult your doctor if Plaquenil causes rapid, excessive or concerning weight gain. They may adjust the dosage or switch medications if the weight gain is impacting your health and mobility. See your doctor for help managing weight gain in any of these situations:

  • Gaining more than 10% of your body weight
  • BMI increasing above 25 into the overweight range
  • Significant increase in waist circumference
  • Shortness of breath or reduced endurance
  • New or worsening joint pain
  • Rapid unexplained weight gain
  • Persistent fluid retention or swelling
  • Fatigue, weakness or reduced mobility
  • New or worsening diabetes
  • High blood pressure

Your doctor can rule out any underlying conditions and provide guidance tailored to your health status. Medical input is particularly important if the weight gain is affecting your physical or mental well-being.


Plaquenil is an effective medication for autoimmune conditions, but weight gain is a common side effect. The drug can increase appetite, cause fluid retention, fatigue and reduced activity, leading to extra weight. Make dietary changes to control portions and hunger levels. Stay active each day despite low energy. Get adequate sleep and prioritize healthy whole foods. If significant weight gain occurs, speak to your doctor about potential solutions. With diligent lifestyle measures and medical guidance as needed, it is certainly possible to maintain a healthy weight while benefiting from Plaquenil.

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