Do Plaquenil (hydroxychloroquine) and Arava (leflunomide) cause weight gain?

Plaquenil and Arava Weight Effects

Neither Plaquenil (hydroxychloroquine) nor Arava (leflunomide) are associated with clinically significant weight gain based on available evidence.

Direct Evidence Assessment

The provided evidence does not contain any guidelines, drug labels, or research studies specifically addressing weight changes with Plaquenil (hydroxychloroquine) or Arava (leflunomide). The evidence focuses primarily on:

• Antiretroviral medications for HIV 1
• Diabetes medications 1
• Antidepressants 2, 3, 4
• Antipsychotics 5, 6
• Various other drug classes 7, 8, 9

Clinical Context from General Medicine Knowledge

Plaquenil (hydroxychloroquine):

• This antimalarial/disease-modifying antirheumatic drug (DMARD) is not recognized as causing weight gain
• Weight changes are not listed among common or significant adverse effects
• Gastrointestinal side effects (nausea, diarrhea) may occasionally lead to weight loss rather than gain

Arava (leflunomide):

• This DMARD used for rheumatoid arthritis is not associated with weight gain
• Common side effects include diarrhea, nausea, and elevated liver enzymes
• Gastrointestinal effects may potentially cause weight loss in some patients

Medications That DO Cause Weight Gain

For context, the evidence clearly identifies medications associated with significant weight gain 8:

Antidepressants causing weight gain:

• Amitriptyline (1.8 kg) 8
• Mirtazapine (1.5 kg) 8
• Paroxetine (highest risk among SSRIs) 3

Antipsychotics causing weight gain:

• Olanzapine (2.4 kg) 8
• Quetiapine (1.1 kg) 8
• Risperidone (0.8 kg) 8

Antidiabetic medications causing weight gain:

• Pioglitazone (2.6 kg) 8
• Glyburide (2.6 kg) 8
• Insulin (associated with weight gain) 1

Clinical Recommendation

If your patient is experiencing weight gain while taking Plaquenil and/or Arava, investigate other causes rather than attributing it to these medications. Consider:

• Other concurrent medications (antidepressants, antipsychotics, diabetes medications, corticosteroids) 7, 8, 9
• Disease activity changes (improved mobility leading to different activity patterns)
• Corticosteroid use (commonly co-prescribed with DMARDs)
• Metabolic or endocrine disorders
• Dietary and lifestyle factors