Has your health care provider or rheumatologist told you to stop taking your hydroxychloroquine (Plaquenil) prescription, or do you have side effects that make you want to stop? If so, you might wonder how long hydroxychloroquine stays in your system and when the side effects should ease up.

Some MyLupusTeam members also asked others about their experiences coming off hydroxychloroquine and how long the drug sticks around. 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 for foreign invaders and attacks them. This misguided action triggers inflammation that damages your skin, joints, and organs over time. Lupus treatments focus on calming this inflammation, helping to protect your body and slow down the disease.

Hydroxychloroquine is an antimalarial — a drug that’s used to prevent or treat malaria, a disease spread to humans by some types of mosquitoes. Doctors also prescribe this medication to treat these autoimmune diseases:

• Systemic lupus erythematosus (SLE), one of the major types of lupus
• Discoid lupus erythematosus (DLE), a form of lupus that causes rashes
• Rheumatoid arthritis, a condition that mostly affects joints

Specifically, hydroxychloroquine stops immune cells from receiving inflammatory signals and prevents them from causing more inflammation. The drug also lowers the amount of autoantibodies or immune system proteins that target 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 can also prevent lupus flares (periods when symptoms worsen) and reduce the risk of organ damage and blood clots.

Hydroxychloroquine Dosing

It takes time for hydroxychloroquine to build up in your system and reach a stable level, so it may take one to three months before you notice its full effects. Your doctor or rheumatologist will likely start you out on a higher dose — typically, 400 milligrams a day. You’ll take this 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, but they should gradually get better the longer you take your medication. After a while, to help prevent side effects, your doctor may adjust your daily dose to fall between 200 and 400 milligrams. Note that the dose your doctor recommends for you may differ from these examples because it’s based on factors such as your body weight.

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 can damage your retina — the light-sensitive tissue in your eye. Be sure to get your eyes checked regularly, and tell your eye doctor if you notice any new vision problems.

How Long Does Hydroxychloroquine Stay in Your System?

Hydroxychloroquine stays in the body for roughly three months. To understand why it remains for so long, it’s important to know about a drug’s half-life — the length of time it takes for the body to break down half the amount of a drug. Hydroxychloroquine’s half-life is just over 22 days.

How Long Does It Take Hydroxychloroquine To Get Out of the System?

If you take a 200-milligram dose of hydroxychloroquine, it takes 22 days for your body to break down half (100 milligrams). For the remaining 100 milligrams, it takes another 22 days to break down half (50 milligrams), and so forth. Therefore, it can take months to clear your system of hydroxychloroquine.

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

What Happens if You Miss a Dose of Hydroxychloroquine?

It’s important to take hydroxychloroquine daily as prescribed by your doctor, but you might miss an occasional dose. Life gets busy, and maybe you forget to refill your prescription or pack your medication for a weekend trip. So, what happens if you miss a dose? Because hydroxychloroquine builds up in your system and takes several days to break down, you likely won’t notice lupus symptoms if you miss a dose or two.

MyLupusTeam members have asked about the effects of missing one or more doses of hydroxychloroquine. One member asked, “I take two 200-milligram 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 that you wait to take your usual dose. Don’t make up a missed dose or double 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 other questions, talk to your health care provider or rheumatologist.

Stopping Hydroxychloroquine Safely

If you experience severe side effects, your doctor may recommend that you completely stop hydroxychloroquine.

Stopping hydroxychloroquine may cause your lupus symptoms to flare up. One study of 1,460 people with SLE found that participants who reduced or discontinued this medication were more likely to experience a flare compared to those who maintained treatment.

Common symptoms of lupus flares include:

• Rashes
• Swollen or painful joints
• Leg swelling
• Fever without an infection
• Extreme tiredness
• New ulcers (sores) in your mouth or nose

MyLupusTeam members have described what happened when they stopped taking 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,” shared another.

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

What Happens if You Suddenly Stop Taking Hydroxychloroquine?

Quitting hydroxychloroquine cold turkey isn’t recommended. If you stop all at once, your symptoms could get worse or you might trigger a disease flare. Even if you’re feeling better, it’s important to keep taking the medication as prescribed. Your doctor will help you slowly reduce the dose if it’s time to stop, giving your body time to adjust.

Adjusting Other Medications

Many people who take hydroxychloroquine take lower doses of their lupus medications. In addition to taking hydroxychloroquine, you might be 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 233,000 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, start a conversation by posting on your Activities page, or connect with like-minded members in Groups.