Different dosage of plaquenil on alternate days

[Jances13]

HI everyone, recently saw my rheumatologist and she stated there are new guidelines for Plaquenil. I have been on plaquenil for 8 years , started with 400 mg a day but now I have been taking only 200 mg a day for the past couple of years but just recently we cut back to 100 mg and oh boy what a big mistake. my whole body went haywire . My malar rash came back, nerve pain , joint pain you name it . So now she has recommended for me to up to 300 mg which is in the new guideline for my weight. She recommended either cutting the pill in half and take 300mg every day or on Mon Wed and Fri to take 400 mg then on Tues, Thurs , Sat and Sun to take only 200mg. Has anyone ever taken different dosages on different days? Does this have the same outcome ? I tried cutting the pill and taking the extra 100 mg at dinner but didn't really sit well with my stomach . I don't know if it is because the pill was cut in half that the medication doesn't have the outside coating or what . Any suggestions greatly appreciated . Happy Thanksgiving everyone

[SjogiBear]

Hydroxychloroquine has a long half life - this is possibly why it takes a while before it builds up in the body and has a therapeutic effect. It also means that if you miss a day you shouldn't notice - I was told this by my rheumy team when I managed to run out for a few days - (if you do it may be the placebo effect) .

So it means that for you taking the additional tablet every other day would be better than taking an extra half every day as this destroys any coating the tablet has and would make gastro trouble more likely. Hope this makes sense? Reading the information leaflet for Plaquenil online it does specifically say NOT to cut the tablet in half: drugs.com/pro/plaquenil.html

"Do not crush or divide Plaquenil film-coated tablets"

[Jances13 in reply to SjogiBear]

Sjogibear , thanks for replying . I didn't know that they recommend not dividing the pill. No wonder my stomach went crazy. I really appreciate the info . It makes sense . Thank you so much . Have a Happy Thanksgiving .

[Jances13]

Hi , thanks so much for replying ,You are absolutely right about the vile taste . My rheumy took my weight which is 133 lbs. which is 60 kg and multiplied by 5 which is 300mg . Does this sound about right . I never realized how well the plaquenil was working till now . Hopefully things will get better soon . Thanks again .

[Unf4bul0us]

I’m 47kg and I take 200mg and 400mg on alternate days which is actually a tiny bit more than I should be on for my weight but my rheumatologist says it’s not enough to make a difference. My tablets come in 200mg so it means I just either take one or two depending the day which is much easier than halving!!! X

[BillScotland]

I am 87 kilos and just had my dosage changed from 600 mg per day to 600\400 alternate days. I had asked for reduction of Cellcept (I have terrible gastric issues) but was advised to stay on 2 grams daily.

So far I have had no issues with change after 1 week.

I feel that my eyesight is deteriorating year on year and wondered if plaquenil was to blame?

[Johnnyb10]

Hi I was on 400mg a day since being diagnosed in 2011, however on my last visit to the consultant he said I could try on a reduced dose, so I take 400mg one day and 200 the next and appear to be ok. I am seeing the rheumatologist in January and will have blood tests prior to that which will tell if all is ok

[Joy_1]

I was taking 300mg a day of HQC, because as you say it is based on your weight.

I did not have any problems. Just made sure I ate half my breakfast to line my stomach before taking the meds then the rest of my breakfast.

As others have said the half life of many drugs is long so day to day does not have much of an impact. In the past when tapering steroids I would be alternating doses eh 6mg one day 5.5 the next.

[Johnnyb10]

No rheumatologist has ever mentioned dosage based on weight to me over the years

[milkwoman in reply to Johnnyb10]

Originally, Plaquenil dosage was based solely upon weight. More recently however, the guidelines also take height into consideration.

[begin excerpt] Go by ideal, not real, weight. Dr. Marmor stressed the importance of not overdosing, which greatly accentuates the risk of toxicity. Therefore, the new guidelines suggest using a person’s height as a dosing factor. By the old standards, obese people, if dosed by their actual weight, could be overmedicated, Dr. Marmor said. If you’re short, the standard prescription of 200 mg of Plaquenil, twice daily, is too much, he said.

The recommended dosage is no more than 6.5 mg/kg/day, using the standard known as “ideal weight,” which factors in height. Dr. Marmor suggested calculating this as follows:

For women, the ideal weight is 100 lbs for 5 feet, plus five lbs per extra inch of height.

For men, the ideal weight is 110 lbs for 5 feet, plus five lbs per extra inch of height.

What if the ideal dose is 300 mg/day? Both Drs. Marmor and Fung suggested alternate-day dosing. “It’s possible to average a dose over the course of two or three days,” Dr. Fung said. “Take two one day and one the next.” [end excerpt]

Source: aao.org/eyenet/article/rx-s...

[Johnnyb10]

Thanks Milkwoman, I have been seeing a rheumatologist since 2011 and no one as ever mentioned height or weight, I have been on 400 mg since that until August when it was suggested I take 400 mg one day and 200mg the next...............I am due my next appointment in early January so might mention about height and weight in relation to dosage

[chrisj]

Yes had mine halved a couple of years ago after taking 400 a day. He eventually halved it to 200 because of the same guidelines you mention Jances. He did say to up the dosage if I felt I needed to but I've been ok so left it at the 200

He staggered the dose to start with and for a while I was on 2 one day, one the next and then he reduced to 200 each day. He mentioned weight as well and concern about the side effects...so far so good

[sflynn84]

I had this issue on my list of questions for my rheumatologist. I am currently on 400mg a day and weigh 128lbs. I am worried about eventually developing the retinal toxicity. I also thought 400mg was aggressive as my only symptom is mild joint pain.

[milkwoman in reply to sflynn84]

Yes, 400 mg is (in theory) too much for your weight. You could try 390 mg and see if you still are able to manage your symptoms.

My rheumy wants me on the smallest dosage possible.