Severe insomnia and limited meds to take while on Hydroxy.

[Mialuke]

Hi all, first timer on this thread. I’ve been on Plaquenil for 5-years to treat RA and also on antidepressant Celexa (10mg) for the last 10 years. In 2022, my primary dr suddenly alarmed me that I can no longer take Celexa due to IQ heart issues that was found during the Covid pandemic when so many folks abused Plaquenil as the miracle drug for covid. I’m suffering with severe insomnia since I’ve been off Celexa (Xanax & melatonin not working). I’m considering to discuss with my Rhemy to taper off Plaquenil and start methotrexate to get back on Celexa, but I’m so concerned of the higher risk and side effects taking methotrexate. I want my quality of life back with sleep. Anyone taking Plaquenil and have insomnia and what sleep meds have worked for you? Thank you.

[Fruitandnutcase]

I take plaquenil but on the whole I don’t have insomnia. I’ve worked very hard on my ‘sleep hygiene’ though as I used to waken up around 3.00 am and lie awake for hours. Sometimes I was only getting 3-4 hours sleep a night. As you know that’s awful.

So for me now it’s a totally blacked out bedroom, no computer, TV, Kindle or anything electronic before bed. I buy paper books from charity shops to read in bed. I don’t drink coffee or alcohol in the evening either.

My husband sleeps in another room so that we don’t disturb each other which has helped a lot . He snores, breathes at a different speed to what I do and likes to sleep in a light bedroom.

It all sounds pretty dull doesn’t it but now I get between 7.5 and 8 hours sleep most nights. I also discovered quite by accident that if I take an antihistamine- citirizine - I sleep really well probably because I’m not all blocked up - I sleep with the window open and there are a lot of trees around where I live.

So to answer your question I do take plaquenil but I have managed to work on things so that I sleep well. I know from my Apple Watch that I waken up on and off during the night but I’m often not aware that I do.

[helixhelix]

If your RA is well controlled with plaquenil then it may be unlikely that your doctor would prescribe methotrexate just to allow you to take extra strong drugs!

As F&N says have you done the max in terms of sleep hygiene? I find of I don’t do some exercise each day I won’t sleep.

[Mialuke in reply to helixhelix]

My RA is thankfully under control with one Plaquenil pill. I have a good sleep hygiene routine to prepare prior to bed and it’s hit and miss with approx 2-5 hours sleep for the last 10 months and last night it was zero sleep. Thank you.

[helixhelix in reply to Mialuke]

If you are controlled with one dose of plaquinil then I really wouldn’t mess with that! Instead push your doctor about other antidepressants you can take as there are some that are ok apparently.

[Mialuke in reply to helixhelix]

Yes, I agree but Plaquenil has a very short list of antidepressants that I can take to help sleep and I’ve tried them all (3) with horrible side effects. Im taking Busbar and it’s not helping. Thanks.

[Boxerlady]

I'm on Mirtazapine (a different AD) which really helps me sleep - in fact, I'm on an extremely low dose just for that reason, despite not needing the AD effect any more. I was already on it when I was diagnosed with RA and given Hydroxychloroquin (and Methotrexate and later Sulphasalzine) so there obviously isn't an interaction problem.

[lindyloo2018 in reply to Boxerlady]

hello I have the same problem re hydroxychloroquine, please share what does of mirtazapine you are on, are you allowed a glass of wine when on a small dose ?

[Boxerlady in reply to lindyloo2018]

Started on 15mg (which was enough for me but think that it could have been increased) and then dropped to 7mg (smallest tablet is 15mg but I cut it in half.) I don't drink but I suspect that you're not meant to as I think that I remember my GP checking that I was still tea-total.

[Mialuke]

Per Gp, trazadone has bad interactions with Plaquenil. Ambien is the only sleeping med I can take and it helped me sleep only 4-hours a night and I felt like a zombie in the morning till afternoon, so not worth taking.

[Mialuke]

Thanks for sharing… I’ve never heard of mirtazapine. Does this help you sleep? Do you take it at night time? I will def ask my gp about this.

[Boxerlady in reply to Mialuke]

Yes. My GP chose it because as well as bring good for anxiety and depression, it also helps you to sleep. It zonked me out for the first couple of doses but then I got used to it and it just helped me to sleep (blissful after trying SO many techniques without success). I could wake up in the night if necessary (e.g. dog emergency or just needing the bathroom) but drop straight back to sleep afterwards. The GP has said that I can stay on it for ever if I want.

[Mialuke in reply to Boxerlady]

Thank you so much!! Spoke to gp and I will start on Mirtazapine tomorrow. All other SSRI have QT internal heart issues with Plaquenil. I was on Celexa for 10 years and had to stop last year due to QT heart issues can occur Have you had any issues with weight gain, which is a side effect? How many mg are you taking? I pray this will help me get some sleep

[Boxerlady in reply to Mialuke]

I didn't have any weight gain although I've always been on the skinny side; now, at 63, I'm "slim" 😂I started on 15 mg and reduced to 7 mg once I no longer needed it for the mood issues; 15 mg is the lowest dose tablet, I cut them in half.

Hope it suits you. I initially took it at bedtime but found that I felt too zonked in the morning so changed to about 9 pm ( going to bed 10 -11 pm) which means I'm sleepy by the time I go to bed but also able to function better first thing. It gives me at least 8 hours sleep!

I found the first few days challenging but I think that's normal when starting ADs.

[Mialuke in reply to Boxerlady]

Ok, thanks for info! We are the same age and it’s always been a challenge to keep my weight balanced with diet and exercise, so I hope the weight gain stays at bay.

[goggigoggi]

I take Plaquenil 200mg in the morning and Amytriptyline 5mg at night which helps greatly with pain and also sleep. Nothing has been said to me about heart issues etc.

[Mialuke in reply to goggigoggi]

Is this Elavil? My gp said I can not take this with Plaquenil due to QT Intervals with heart issues.

[goggigoggi]

Looks indeed like they are one and the same. Was never told anything about long QT intervals, will have to enquire.

Hope you get sorted soon 👍🏻

[Mialuke in reply to goggigoggi]

Elavil was my first choice since I took it over 25 years ago for sleep issues and it helped, but gp said it had interactions with Plaquenil - I was so bummed. Unfortunately, Taking Plaquenil there’s a very short list of AD meds available.

[goggigoggi in reply to Mialuke]

That's a pity. I'm interested to see how you get on with the Mirtazapine, hopefully well 🤞

[lindyloo2018 in reply to Mialuke]

hi did they tell you what AD you could take with hydroxychloroquine ? which ones are ok ? many thanks

[Africschoice in reply to lindyloo2018]

I take duloxetine with mine

[lindyloo2018 in reply to Africschoice]

ok thanks, please could you tell me what the dose is ? mg ?

[Mialuke]

the short list I was given: Paxil, Zoloft and Busbar. I was not able to handle the side affects from Paxil and Zoloft. Busbar was okay, but only good for anxiety and not insomnia.

[Vonnie10]

Hi I take mirtazpine for sleep I usually take 20 but gp increased it for a coiole of weeks im going through something right now .