Hydroxychloroquine (Plaquenil) is both an antimalarial and a disease-modifying anti-rheumatic drug (DMARD). It was approved by the U.S. Food and Drug Administration (FDA) in the 1950s to treat autoimmune diseases like rheumatoid arthritis and lupus. Constipation isn’t listed as a common side effect of hydroxychloroquine, but members of MyLupusTeam have reported experiencing this symptom while taking the drug.

“Does anyone know if hydroxychloroquine can cause constipation?” asked a member of MyLupusTeam, adding, “I have not had a bowel movement in at least four days. I normally don’t have this issue. Usually, it’s the opposite. Wondering if it can be from the medication.”

Another responded, “I had that problem when I was first placed on multiple meds, but I included a daily stool softener to keep regular.”

Some of the more common gastrointestinal side effects include cramps, diarrhea, vomiting, and nausea. These should improve after a few days as your body adjusts to the medication. If you’re struggling with constipation, here are other possible causes and ideas that can help.

Lupus and Constipation

Lupus affects the digestive system in various ways, leaving some people with diarrhea and others with constipation. In addition, nervous system changes from lupus can affect regularity. Some people with lupus also have irritable bowel syndrome (IBS) that causes constipation and other symptoms, including abdominal pain and gas. It’s also possible that other lupus medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids, are affecting your gastrointestinal tract.

One study found that chronic constipation affects about 6 percent of people with systemic lupus erythematosus (SLE) and that another 6 percent have chronic constipation with epigastric (upper abdomen) pain. Unfortunately, changing your medication or the course of your disease isn’t always possible. Lifestyle changes are a good first defense against constipation, followed by medical advice from your doctor if the problem persists.

How To Treat Constipation

There are several steps you can take to reduce constipation. Changing your diet, taking supplements, using laxatives, and reviewing your medications can help. One member shared a home remedy that works for them: “I take a cup of cucumber, a cup of fresh-cut pineapple, and 2 tablespoons of fresh ground ginger. Then, I add a cup of water and blend it into juice,” they explained. “I make enough for two days. I drink 8 ounces every morning, and I’m so happy.”

While you don’t have to try this exact recipe, a morning smoothie or glass of water might help get things moving early in the day. Here are some other tips for treating constipation at home.

Eat Enough Fiber

Eating a diet high in fiber can help prevent constipation and a host of other health problems, like high cholesterol and elevated blood sugar levels. Fiber helps move food through the digestive system to keep you regular. According to the Academy of Nutrition and Dietetics, women should aim for 25 grams of fiber per day and men should try to get 31 grams per day.

You can find fiber in unprocessed plant foods (like fruits, vegetables, and beans) along with some processed foods, like whole-grain bread. Avoid peeling fruits and vegetables, like apples and potatoes, to get more fiber in your diet. You can check food labels for fiber content under the carbohydrates section. Many people find eating prunes makes it easy to get more fiber in their diet and avoid constipation.

It’s important to note that fiber mixes with water in the digestive tract to do its job. If you’re eating more fiber, you should increase your water consumption as well. Eating too much fiber without enough water can lead to constipation. Drinking plenty of water throughout the day will help keep stool (poop) soft and easier to pass.

Consider Supplements and Laxatives

Laxatives can help you get through a rough patch with constipation, and several different types are available. They include:

• Bulk-forming laxatives — These contain fiber that draws water into your stool, softening it up and stimulating your bowels. Examples include methylcellulose (Citrucel), psyllium (Metamucil), and wheat dextrin (Benefiber).
• Enema laxatives — These are fluids you administer into your rectum that coat your poop with slippery substances to make them easier to pass. These may include mineral oil, tap water, and soap suds.
• Osmotic laxatives — Considered one of the gentler types of laxatives, these work by increasing the amount of water in your colon, which softens your stool and makes it easier to pass. Examples include polyethylene glycol (MiraLax), magnesium hydroxide (also known as milk of magnesia), and lactulose, a sugar-based laxative sold under a variety of brand names.
• Stimulant laxatives — Among the more aggressive types of laxatives, these activate the nerves and muscles of the digestive tract to speed up bowel movements. Bisacodyl (Dulcolax) and senna (Senokot) are two examples.
• Stool softeners — Technically a type of laxative, these increase how much water is in your stool to make it softer and easier to pass. Docusate calcium (Surfak) and docusate sodium (Colace) are examples.

MyLupusTeam members have shared their experiences with laxatives:

• “I mix in a packet of polyethylene glycol (MiraLax) with orange juice or apple juice. You can’t taste it, and it doesn’t ‘hit you hard’ like a regular laxative.”
• “1/2 teaspoon of Metamucil with every meal. It works well for me, and I haven’t had a problem since.”
• “I have found that taking a magnesium citrate pill every night helps. I struggle with an unbalanced digestive system, and I believe this has worked wonders. It took a few days, but now, I am regular.”

Before taking magnesium supplements, it’s important to ask your rheumatology or primary care provider if they’re safe for you, especially if you have kidney disease. Most laxatives aren’t intended for long-term use. If you find yourself relying on laxatives every time you need to use the bathroom, talk to your health care provider about sustainable alternatives.

Notably, health experts recommend using stool softeners, such as docusate sodium, alongside other types of laxatives to increase their effectiveness and provide extra comfort.

Review Your Pain-Management Options

Some members have reported constipation with hydroxychloroquine but noticed that this symptom was worse when also taking opioid pain medication. “I’ve been on hydroxychloroquine for eight years, and I have experienced constipation,” shared one member. “I take polyethylene glycol (MiraLax) to help. The constipation from hydroxychloroquine gets worse when coupled with pain meds.”

Another explained, “When taking high-dose opioids, I would go weeks without having a bowel movement. It got so bad that on two occasions, I had to go to urgent care. … I tried Miralax, prunes, prune juice, copious amounts of water, and Benefiber, with minimal success.”

The member went on to explain that eating a healthier diet, including more berries, has helped reduce their constipation.

Research suggests that between 40 percent and 95 percent of people who take opioids develop a condition called opioid-induced constipation. And unfortunately, laxatives aren’t always effective against constipation caused by opioids. Opioids and other pain medications can be essential for people with lupus, particularly during flare-ups. However, finding other options can help you avoid unpleasant side effects like constipation.

Treating the underlying cause of pain with physical therapy or immunosuppressants to control flares may be a better course of action. Heating pads can be helpful for sore muscles and joint pain.

Additionally, healthy exercise and sleep habits may help with both constipation and lupus in general. Ask to meet with a mental health care professional and explore activities like yoga, meditation, and tai chi to support your lupus treatment. Getting more physical activity can boost your mental health and promote regularity.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, over 223,000 people with lupus come together to ask questions, give advice, and share their stories.

Have you experienced any serious side effects from hydroxychloroquine or other lupus medications? If you have constipation, what lifestyle changes, over-the-counter products, or prescriptions do you find helpful? Post your thoughts in the comments below, or start a conversation on your Activities feed.