Hydroxychloroquine Dosing for Rheumatoid Arthritis
For a patient with RA already on methotrexate 25mg weekly, add hydroxychloroquine at 200-400mg daily (typically 400mg daily in divided doses or as a single dose). 1
Standard Dosing Regimen
The FDA-approved dosing for hydroxychloroquine in rheumatoid arthritis is straightforward 1:
- Initial dosage: 400-600mg daily, given as a single daily dose or two divided doses 1
- Chronic maintenance dosage: 200mg once daily to 400mg daily, as a single dose or two divided doses 1
- Most common regimen: 200mg twice daily (400mg total daily) 2, 3
Critical Safety Consideration
The daily dose must not exceed 5mg/kg of actual body weight, as doses exceeding this threshold significantly increase the risk of retinopathy. 1
For example:
- A 70kg patient should not exceed 350mg daily
- An 80kg patient should not exceed 400mg daily
- A 90kg patient can safely take 400mg daily (4.4mg/kg)
Combination Therapy Context
Since your patient is already on methotrexate 25mg weekly, adding hydroxychloroquine is appropriate 1, 2:
- Hydroxychloroquine can be used concomitantly with methotrexate and other antirheumatic agents 1
- The combination of methotrexate and hydroxychloroquine is more effective than methotrexate alone, with 77% of patients achieving sustained improvement when all three drugs (MTX + HCQ + sulfasalazine) were used versus 33% with methotrexate alone 2
- After initial combination therapy, hydroxychloroquine maintenance therapy (400mg daily) successfully extends the response and delays disease flare 3
Practical Administration
- Administer with food or milk to minimize gastrointestinal side effects 1
- Do not crush or divide tablets 1
- The therapeutic effect is cumulative and may require weeks to months for maximum benefit 1
Monitoring Requirements
While hydroxychloroquine has a favorable safety profile compared to other DMARDs 4, ophthalmologic monitoring for retinopathy is essential, particularly at doses approaching 5mg/kg actual body weight 1.