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Hydroxychloroquine

Also indexed as: Plaquenil®

Hydroxychloroquine is used to prevent and treat acute attacks of malaria and to treat both acute and chronic rheumatoid arthritis and lupus. It is in a class of drugs known as antimalarials.

Interactions with Dietary Supplements

Calcium and Vitamin D
Normally, the active form of vitamin D increases the absorption of calcium into the body. In a 45-year-old woman with sarcoidosis, taking hydroxychloroquine blocked the formation of active vitamin D, which helped normalize elevated blood levels of calcium in this case.1 Whether hydroxychloroquine has this effect in people who don’t have sarcoidosis or elevated calcium is unknown. Until controlled research explores this interaction more thoroughly, people taking hydroxychloroquine might consider having their vitamin D and/or calcium status monitored by a health practitioner.

Vitamin B6
An individual who took hydroxychloroquine and vitamin B6 together for nine years experienced a complete disappearance of skin nodules caused by rheumatoid arthritis.2 Controlled study is needed to determine whether taking vitamin B6 with or without hydroxychloroquine might help eliminate nodules in people with rheumatoid arthritis.

Magnesium
Magnesium supplementation may reduce blood levels of chloroquine, a compound similar to hydroxychloroquine, and decrease its effectiveness.3 Until more is known, people taking hydroxychloroquine for arthritis who are also using magnesium supplements and are not experiencing relief might try avoiding the supplements or taking them at separate times.

Interaction with Foods and Other Compounds –––

Hydroxychloroquine should be taken with food to avoid possible stomach upset.4

Summary of Interactions for Hydroxychloroquine

Depletion or interference Calcium*
Vitamin D*
Adverse interaction None known
Side effect reduction/prevention None known
Supportive interaction Vitamin B6*
Reduced drug absorption/bioavailability Magnesium*

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Barre PE, Gascon-Barre M, Meakins JL, Goltzman D. Hydroxychloroquine treatment of hypercalcemia in a patient with sarcoidosis undergoing hemodialysis. Am J Med 1987;82:1259–62.

2. McCarty DJ. Complete reversal of rheumatoid nodulosis. J Rheumatology 1991;18:736–7.

3. Olin BR, ed. Anti-infectives, Antimalarial Preparations, 4-Aminoquinoline Compounds. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, 1993, 1913–6.

4. Olin BR, ed. Anti-infectives, Antimalarial Preparations, 4-Aminoquinoline Compounds. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, 1993, 1913–6.