Hydroxychloroquine ( HCQ) is a Disease Modifying Anti-Rheumatic Drug (DMARD). It is a relatively mild drug and can be used alone in mild cases of rheumatoid arthritis (RA) or as add on to other DMARDs. The most common combination is with Methotrexate (MTx). It is a very important drug in the treatment of SLE and prevention of flares of the disease and is also used in certain other Illnesses. The beauty of Hydroxychloroquine lies in its safety. It can be given for years together. It does not have any side effects on the liver, kidneys or bone marrow etc. In fact, it helps the liver by protecting it against some of the other drugs metabolized by the liver such as Methotrexate. It has a beneficial effect on the Lipid profile as well and possibly is helpful in diabetic patients.
The dose of hydroxychloroquine is 6 mg per kg per day, upto a maximum dose of 400 mg / day. Its onset of action is slow (3 to 6 months) and it persists in the body for long periods. Western studies estimate the chances of a side effect at one in 7000 patients. There is no data from India. Acidity is one possible side effect. Because it may sometimes cause nausea and vomiting, it should always be taken after a meal. Chronic use may result in skin pigmentation and itching. When used for long periods it sometimes affects vision. In all these years we have barely a few patients experience these effects. However we must never let down our guard. We need to be careful. That is why it is mandatory to have a eye specialist (opthalmologist) check your eyes once every 6 months, even if you believe there is nothing wrong or abnormal with your vision.
The eye checkup is important so that the moment a change in the retina is noticed, the drug can be immediately discontinued and visual impairment is avoided. Some patients argue that they do not feel the need to go back to the Opthalmologist as they have already undergone cataract surgery. This is a mistake. What is required here is the specific examination of the retina by an Opthalmologist, with a fundoscope. Many make the mistake of consulting an Optician. All the Optician knows is how to check your eye’s refraction or ‘spectacle number’ as it is commonly referred to.