From the Guidelines
Mycophenolate and hydroxychloroquine (Plaquenil) can generally be taken together safely as there are no significant drug interactions between them. These medications work through different mechanisms and are often prescribed together for autoimmune conditions like lupus or rheumatoid arthritis. Mycophenolate suppresses the immune system by inhibiting lymphocyte proliferation, while hydroxychloroquine has anti-inflammatory properties and modulates immune responses through different pathways.
Key Considerations
- When taking these medications together, patients should continue their prescribed dosages without adjustment unless directed by their healthcare provider 1.
- Both medications can cause gastrointestinal side effects like nausea, vomiting, or diarrhea, which might be more pronounced when taken simultaneously.
- Taking mycophenolate with food and hydroxychloroquine with a meal or milk may help reduce these effects.
- Regular monitoring by a healthcare provider is important, including blood tests to check for potential side effects on blood cells, liver, and kidney function 1.
- Patients should report any unusual symptoms promptly, especially vision changes, as hydroxychloroquine can rarely cause eye problems with long-term use.
Monitoring and Precautions
- Patients on mycophenolate should be aware of the potential for increased risk of opportunistic infections and certain malignancies, as noted by the FDA alert 1.
- Hydroxychloroquine is recommended for all patients with lupus nephritis, according to the joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations 1.
From the Research
Drug Interactions Between Mycophenolate and Plaquinil
- There are no direct studies on the interaction between mycophenolate and plaquenil (hydroxychloroquine) in the provided evidence.
- However, studies have shown that mycophenolic acid, the active metabolite of mycophenolate, has a high potential for drug-drug interactions due to its complex pharmacokinetics 2.
- Cyclosporine, a calcineurin inhibitor, has been shown to reduce mycophenolic acid exposure by 40% due to inhibition of enterohepatic recirculation 3.
- Hydroxychloroquine, on the other hand, is used in the treatment of systemic lupus erythematosus and has been shown to have a positive impact on disease activity and survival 4.
- While there is no direct evidence on the interaction between mycophenolate and plaquenil, it is essential to monitor patients for potential drug-drug interactions when coadministering these medications, as mycophenolic acid has a narrow therapeutic index and small changes in its concentration can lead to adverse effects or reduced efficacy 2.