From the Guidelines
Discontinuing Plaquenil (hydroxychloroquine) should not be done without adequate cause, as it is an important drug for controlling many rheumatic diseases.
Key Considerations
- The decision to discontinue HCQ should be made through shared decision-making involving the patient, prescribing physician, and eye care provider 1.
- Retinopathy generally develops slowly, over several years, allowing time for suspicious findings to be rechecked or for further tests to be conducted 1.
- Suggestive or uncertain findings should be discussed with the patient and prescribing physician to justify further examinations, but the drug need not be stopped until evidence of retinopathy is definitive 1.
- The severity of the rheumatic disease and estimated risk of visual loss if the drug is continued should be considered when making the decision to discontinue HCQ 1.
Discontinuation Approach
- If retinopathy is suspected, further tests such as multifocal electroretinography or fundus autofluorescence imaging may be necessary to confirm the diagnosis 1.
- The patient should be informed of the potential risks and benefits of continuing or discontinuing HCQ, and their preferences should be taken into account in the decision-making process 1.
From the FDA Drug Label
Discontinue hydroxychloroquine sulfate if cardiotoxicity is suspected or demonstrated by tissue biopsy. If ocular toxicity is suspected, discontinue hydroxychloroquine sulfate and monitor the patient closely given that retinal changes and visual disturbances may progress even after cessation of therapy. Discontinue hydroxychloroquine sulfate if these severe reactions occur. Discontinue the drug if the patient develops myelosuppression which cannot be attributable to the disease. Discontinue hydroxychloroquine sulfate if muscle or nerve toxicity is suspected or demonstrated by tissue biopsy. Discontinue hydroxychloroquine sulfate if renal toxicity is suspected or demonstrated by tissue biopsy.
The recommended way to discontinue Plaquenil (hydroxychloroquine) is not explicitly stated in the provided drug labels. However, it can be inferred that the drug should be discontinued if any of the following conditions are suspected or demonstrated:
- Cardiotoxicity
- Ocular toxicity
- Severe skin reactions
- Myelosuppression
- Muscle or nerve toxicity
- Renal toxicity 2 2
From the Research
Discontinuing Plaquenil (Hydroxychloroquine)
To discontinue Plaquenil (hydroxychloroquine), the following factors should be considered:
- The risk of poor outcomes after hydroxychloroquine taper or discontinuation is higher in certain patient groups, such as those with baseline prednisone use, Black patients, and those diagnosed with SLE at age ≤25 years 3
- A shared decision-making tool, such as HCQ-SAFE, can facilitate hydroxychloroquine adherence and safe, effective use by engaging patients in therapeutic decision-making 4
- Hydroxychloroquine has a range of potential toxicities, including gastrointestinal, glucose abnormalities, cardiotoxicity, dermatologic, and neuropsychiatric effects, which should be monitored during treatment 5
Tapering Hydroxychloroquine
When tapering hydroxychloroquine, the following points should be considered:
- The risk of poor outcomes after hydroxychloroquine taper is higher in patients with certain demographic and clinical factors, such as baseline prednisone use 3
- A gradual tapering schedule may be necessary to minimize the risk of adverse effects
- Patients should be closely monitored for signs of disease flare or toxicity during the tapering process
Alternative Treatments
In some cases, alternative treatments may be necessary for patients who are discontinuing hydroxychloroquine, such as:
- Other disease-modifying anti-rheumatic drugs (DMARDs) for patients with SLE or other rheumatic diseases
- Topical or systemic corticosteroids for patients with discoid lupus erythematosus (DLE) or other skin conditions
- Other treatments for patients with nephrology conditions, such as IgA nephropathy or lupus nephritis 6