Can I take Plaquenil (hydroxychloroquine) one day prior to surgery?

Perioperative Management of Plaquenil (Hydroxychloroquine) Before Surgery

You can safely continue taking Plaquenil (hydroxychloroquine) one day prior to surgery and through the perioperative period, as it does not increase bleeding risk and does not require discontinuation before surgical procedures.

Understanding Hydroxychloroquine in the Perioperative Setting

• Unlike anticoagulants and antiplatelet medications that require careful perioperative management, hydroxychloroquine (Plaquenil) does not affect platelet function or coagulation and does not need to be discontinued before surgery 1
• Hydroxychloroquine is not included in any perioperative medication management guidelines that recommend discontinuation, as it does not increase bleeding risk 1
• The American College of Chest Physicians guidelines for perioperative management of antithrombotic therapy do not list hydroxychloroquine among medications requiring interruption 1

Medications That DO Require Perioperative Discontinuation

• Anticoagulants like warfarin typically need to be stopped 5-6 days before surgery to allow normalization of INR 1
• Antiplatelet medications such as clopidogrel and prasugrel should be discontinued 5-7 days before surgery in most cases 1
• NSAIDs with antiplatelet effects require varying discontinuation periods: 1 day for ibuprofen, 4 days for naproxen, and up to 10 days for piroxicam 2

Special Considerations for Hydroxychloroquine

• Sudden discontinuation of hydroxychloroquine in patients with rheumatoid arthritis or lupus may lead to disease flares, which could complicate postoperative recovery 3
• Maintaining hydroxychloroquine therapy throughout the perioperative period helps prevent flares of underlying autoimmune conditions 3
• Unlike medications that affect hemostasis, hydroxychloroquine does not increase the risk of surgical bleeding or complicate neuraxial anesthesia 1

Perioperative Management Algorithm for Common Medications

• Anticoagulants: Stop warfarin 5 days before surgery; DOACs (dabigatran, rivaroxaban, apixaban) 2-5 days before surgery depending on renal function and bleeding risk 1
• Antiplatelet agents: Continue aspirin for most surgeries if used for secondary prevention; stop P2Y12 inhibitors (clopidogrel, prasugrel) 5-7 days before surgery 1, 4
• NSAIDs: Stop 1-10 days before surgery depending on the specific agent 2
• Hydroxychloroquine and other DMARDs: Continue through the perioperative period 3

Potential Pitfalls and Considerations

• Do not confuse hydroxychloroquine with anticoagulant or antiplatelet medications that do require discontinuation 1
• Always inform your anesthesiologist about all medications you are taking, including hydroxychloroquine, even though it doesn't affect surgical bleeding risk 1
• For high-bleeding-risk procedures (neurosurgery, spinal surgery in the medullary canal, posterior chamber eye surgery), discuss all medications with your surgeon, but hydroxychloroquine generally does not need to be stopped 4

Conclusion for Specific Surgical Settings

• For minor procedures (dental, dermatological, cataract surgery): Continue hydroxychloroquine without interruption 1
• For major surgeries including orthopedic, cardiovascular, and abdominal procedures: Continue hydroxychloroquine throughout the perioperative period 1, 3
• For emergency surgeries: No need to delay surgery due to hydroxychloroquine use 1