Hydroxychloroquine (Plaquenil) and Coronavirus (COVID-19) Questions and Answers
This is part of our ongoing coverage of the coronavirus and how it affects those living with lupus. Make sure you also take a look at our FAQs answered by our Health Educators for overall health advice for people with lupus dealing with the coronavirus. We also have tips for refilling your hydroxychloroquine (Plaquenil) prescription.
I am reading that hydroxychloroquine (Plaquenil) may help in fighting the coronavirus (COVID-19).
Answer: The U.S. Food and Drug Administration (FDA) has not approved hydroxychloroquine (Plaquenil) for the treatment of COVID-19, the illness caused by the coronavirus. There have been a number of studies of hydroxychloroquine and COVID-19 and at this time the best available evidence suggests that hydroxychloroquine is not effective in the treatment and prevention of COVID-19, and the potential benefits of the drug do not outweigh the known and potential risks. As a result, the FDA has revoked their earlier issue of an Emergency Use Authorization (EUA) for hydroxychloroquine. An EUA allows for an unapproved drug to be prescribed in limited and controlled ways during an emergency such as a pandemic. The FDA has cautioned against the use of hydroxychloroquine to treat COVID-19 outside of a hospital or clinical trial.
The only FDA approved treatment for COVID-19 is the antiviral drug remdesivir (Veklury®). Remdesivir was approved for patients over 12 years old and weighing at least 88 pounds who are hospitalized with COVID-19. It is important for people with lupus to know that the studies reviewed by the FDA showed that remdesivir was less effective when used with hydroxychloroquine or chloroquine, both common lupus medications. If you are prescribed remdesivir, it is very important to tell your doctor what other prescription and non-prescription medications you are taking.
I have been taken off hydroxychloroquine. Should I start taking it again?
Answer: You should not make any changes to your lupus medication or treatment plan unless directed by your lupus doctor. Your doctor knows your symptoms and health status best.
Is there a shortage of hydroxychloroquine?
Answer: The Food and Drug Administration (FDA) is reporting that the shortage of hydroxychloroquine has been resolved. It is possible that people with lupus are still having trouble filling their prescriptions at this time. We are continuing to work with all relevant stakeholders to ensure that people with lupus have access to the medications they need. If you are having trouble filling your prescription, we have some strategies for refilling your prescription that may be helpful.
If I am already on hydroxychloroquine, am I not as high risk for contracting the coronavirus?
Answer: According to the Centers for Disease Control and Prevention individuals with serious underlying health conditions are at risk of getting very sick from the coronavirus.
There is no evidence that taking hydroxychloroquine is effective in preventing a person from contracting the coronavirus. People with lupus should follow the guidance of their doctor and the safety guidelines being issued by the CDC.
If you are at higher risk of getting very sick from the coronavirus, you should:
- stock up on supplies;
- take everyday precautions to keep space between yourself and others.
When you go out in public:
- wear a cloth or disposable face mask;
- keep away from others who are sick;
- limit close contact and wash your hands often;
- avoid crowds and non-essential travel.
If there is an outbreak in your community, stay home as much as possible.
Watch for symptoms and emergency signs. If you get sick, stay home and call your doctor.
More information on how to prepare, what to do if you get sick, and how communities and caregivers can support those at higher risk is available on People at Risk for Serious Illness from COVID-19.
Can the use of hydroxychloroquine prevent coronavirus (COVID-19)?
Answer: No. There is no evidence that taking hydroxychloroquine is effective in preventing a person from contracting the coronavirus or developing COVID-19, so people who are not already taking this medication do not need to start it now. People with lupus should follow the guidance of their doctor and the safety guidelines being issued by the US Centers for Disease Control and Prevention (CDC) for people with compromised immune systems.
How can I get an extended supply of the medication?
Answer: Only your doctor can increase your prescription quantity. The amount you can receive at one time also will depend on the policies of your health insurance carrier or government-sponsored healthcare program (such as Medicare or Medicaid).
Will insurance pay for an extended supply of hydroxychloroquine?
Answer: Reimbursement for extended supplies of a prescription drug will depend on the terms of your insurance coverage or the policies of government heathcare programs, such as Medicare and Medicaid. Please contact your insurance carrier for details.
Are there alternative medications I can use?
Answer: Unfortunately, there are no good alternatives to hydroxychloroquine for people who need these medications. They are in a class by themselves and have the advantage of not being immunosuppressive. This is unlike many other therapies, including glucocorticoids like prednisone that increase risk of infections of all kinds. Your doctor will know best what alternatives may be available for you. Please do not make any changes to what medicines you take or how you take them without talking to your doctor. For additional information on treatments used for lupus see: www.lupus.org/understanding-lupus/treatment
What should lupus patients do if their pharmacy runs out of hydroxychloroquine?
We encourage people with lupus to keep checking other pharmacies in their area that they can safely get to or call on the phone, and reach out to larger pharmacies that offer delivery. If you continue to have trouble accessing your medication, we recommend you reach out to your physician to seek help and discuss a broader health plan during the coronavirus (COVID-19) pandemic.
We are continuing to work with the government, including Congress, the White House and state governments, and urging drug manufacturers to ensure people with lupus have access to the medications needed.
I am anxious that I will not be able to fill my prescription for hydroxychloroquine. Should I cut back on my dosage to make my prescription last longer?
We recommend you do not make any changes to your dosage amount without the approval of your prescribing doctor. Read more about filling your prescriptions during potential shortages.
Is it true that hydroxychloroquine will keep working 45 days after I have stopped taking it?
Hydroxychloroquine is a longer acting medication that can take several months to build up in the body and become effective. It can also take several weeks for the medication to “leave the body” or no longer be effective after you have stopped taking it. This is referred to as a medication’s half-life -- the length of time it takes for the medication to reduce to 50% concentration in the body.
Although hydroxychloroquine has a longer half-life -- around 40-45 days – than many medications, it is most effective and safe at its prescribed dosage. It is important to continue the prescribed dosage unless your prescribing doctor says otherwise. Stopping usage and relying on the medication’s half-life could lead to lupus flares. If the regular dosage is eventually restarted, it will also require an extended period of time for it to be effective again.