hydroxychloroquine and tapering?

[Gatorchief]

I’m starting to taper down again from 15mg and was curious what the recommended dose of hydroxychloroquine is for tapering ? Does it help to avoid a flare?

[PMRpro Ambassador]

No answer to that - it works for some people but only a few and doesn't make any difference to others. All you can do is try and see if it helps you get to a lower dose of pred but you still need to taper the way we suggest for pred alone until you find out if it is going to work for YOU. And there is a fairly standard dose of most DMARDs so no real "best" dose.

If you start HCQ, you need to have a thorough eye exam first and at annual intervals afterwards as the worst adverse effect affects vision and can be severe if not noticed. And it can happen relatively suddenly even after years on it so do be careful.

[Gatorchief in reply to PMRpro]

Thank you, vision side effects are a serious side effect and not mentioned in the list of side effects I found.

[PMRpro Ambassador in reply to Gatorchief]

eyewiki.org/Hydroxychloroqu....

arthritis.org/drug-guide/me...

The second link emphasises the risk of the dose being too high.

[Gatorchief in reply to PMRpro]

Great paper explaining the risks of the therapy. 5 yrs seems to be the critical point for most users, but as the paper states, damage might already be done in the asymptomatic patient. I’m guessing that if I couldn’t taper down to 4-5 mg of prednisone a day within a yr and stop taking it, that the risk for eye damage could be very concerning from there on. Thank you again.

[PMRpro Ambassador in reply to Gatorchief]

It is used quite a lot in lupus - and I know of people who had problems in well under 5 years. But bear in mind that you might taper down while on it but without it, the low dose of pred may no longer be enough. That happens with MTX, people stop it thinking it is doing nothing and immediately flare. Same with leflunomide.