Yes, Plaquenil Can Cause Diarrhea
For many patients, gastrointestinal (GI) side effects, including diarrhea, are a recognized possibility when taking Plaquenil (hydroxychloroquine). These symptoms often arise early in treatment as the body adjusts to the new medication. Clinical studies list diarrhea as a common side effect, typically affecting between 1% and 10% of users, though other sources indicate that gut-related issues might occur in up to 37% of people. The good news is that these symptoms are often temporary and can be managed effectively with a few simple strategies.
Why Plaquenil Can Cause Gastrointestinal Issues
The exact mechanism for why Plaquenil causes GI distress is not fully understood, but it is a well-documented phenomenon. Plaquenil is thought to interfere with immune system communication, and this process can sometimes affect the digestive system. The GI tract is a sensitive area, and introducing a new drug can upset the balance of bacteria and the overall mucosal lining, leading to symptoms like diarrhea, nausea, and abdominal pain. While most cases are mild, it is important for patients to be aware and proactive in managing these effects to ensure they can continue their treatment comfortably.
How to Manage Plaquenil-Induced Diarrhea
Medication Timing and Food
One of the most effective and simplest methods for managing stomach upset is to take your Plaquenil dose with a meal or a glass of milk. The presence of food in the stomach can buffer the medication and minimize its direct irritation on the GI tract, reducing the likelihood of nausea, cramps, and diarrhea.
Dose Adjustments
If taking the medication with food does not provide sufficient relief, your doctor may recommend adjusting your dosage. In some cases, splitting the daily dose into two smaller doses (e.g., morning and evening) can be gentler on the stomach. A doctor may also start you on a lower initial dose and gradually increase it over time to help your body adapt. It is crucial to only make these adjustments under the guidance of a healthcare professional.
Dietary Strategies
Certain dietary choices can further help manage diarrhea symptoms. Consider these tips:
- Avoid trigger foods: High-fat, greasy, heavily spiced, or acidic foods can exacerbate GI distress. Limiting these can help settle your stomach.
- Eat smaller, more frequent meals: This can prevent the stomach from feeling overly full and reduce the pressure on your digestive system.
- Incorporate bland foods: The BRAT diet (bananas, rice, applesauce, toast) is often recommended for soothing the digestive system during bouts of diarrhea.
- Stay hydrated: Chronic diarrhea can lead to dehydration and loss of essential electrolytes. Drinking plenty of water and low-sugar electrolyte drinks is vital.
Over-the-Counter Aids
For some patients, a doctor might recommend an over-the-counter (OTC) anti-diarrheal medication, such as loperamide (Imodium A-D). However, you should never take an OTC medication without first discussing it with your healthcare provider to ensure it's safe to combine with your Plaquenil and other treatments.
When to Contact Your Doctor
While mild, temporary diarrhea is common, certain symptoms may indicate a more serious issue that requires medical attention. You should contact your doctor immediately if you experience:
- Diarrhea lasting more than two days
- More than six episodes of diarrhea in 24 hours
- Bloody, black, or tarry stools
- Diarrhea accompanied by a fever over 102°F
- Signs of severe dehydration, such as dizziness, dark urine, or extreme thirst
Plaquenil vs. Other DMARDs: A Comparison of GI Side Effects
| Medication | Common GI Side Effects | Key Differentiating Side Effects |
|---|---|---|
| Plaquenil (Hydroxychloroquine) | Nausea, abdominal pain, diarrhea, loss of appetite | Retinal toxicity (rare), cardiomyopathy (rare), changes in blood cell counts |
| Malarone (Atovaquone/proguanil) | Abdominal pain, headache | Headache, insomnia, fever, increased risk with kidney problems |
| Benlysta (Belimumab) | Nausea, diarrhea, stomach pain | Pain in arms/legs, depression, UTIs, reduced white blood cells |
| Methotrexate | Nausea, vomiting, diarrhea, stomach pain | Liver problems, lung disease, mouth sores (based on typical DMARD profiles) |
This comparison is for informational purposes only. Treatment decisions should always be made in consultation with a qualified healthcare provider.
Conclusion
Yes, Plaquenil can cause diarrhea, but it is often a manageable and temporary side effect. By taking your medication with food, staying hydrated, and being mindful of your diet, you can significantly reduce GI distress. Knowing when to contact your doctor is crucial for safety and effective treatment, particularly if symptoms are severe or persistent. Most importantly, do not stop taking your medication or adjust the dose without first speaking with your healthcare provider to ensure you continue to benefit from this important treatment.
What to Do If You Experience Plaquenil Diarrhea
- Take with meals: Always take Plaquenil with food or milk to minimize stomach irritation.
- Hydrate frequently: Drink plenty of water and consider low-sugar electrolyte solutions to replenish lost fluids.
- Avoid trigger foods: Limit fatty, spicy, and greasy foods that can worsen digestive upset.
- Consider dose changes: Discuss with your doctor whether splitting your dose or temporarily lowering it is appropriate.
- Use OTC treatments cautiously: Never start an anti-diarrheal without consulting your doctor first.
- Report severe symptoms: Contact your healthcare provider immediately if symptoms are severe, bloody, or accompanied by a fever.
