Hydroxychloroquine for SLE in adults

Note: Hydroxychloroquine is usually the first-line drug recommended for all patients with SLE, unless contraindicated.

Hydroxychloroquine is usually the first-line drug recommended for all patients with SLE, unless contraindicated. Ideally, the patient should remain on oral hydroxychloroquine for life. It has been shown to:

  • have few harms
  • be safe to use throughout pregnancy
  • reduce the risk of disease flare
  • reduce the frequency of acute serositis
  • reduce cardiovascular riskDrosos, 2022 through its antiaggregant effect on platelets and its lipid-lowering effect.

Despite a lack of clinical outcome data, hydroxychloroquine can reduce the risk of cardiovascular events and improve blood lipid levels in people with SLEDrosos, 2022. This is important because SLE is an independent risk factor for premature atherosclerotic cardiovascular disease. Cardiovascular risk in people with SLE is up to 50-fold higher compared with the general population.

The usual regimen for hydroxychloroquine in adults with SLE isFanouriakis, 2021:

hydroxychloroquine 200 to 400 mg (up to 5 mg/kg actual body weight) orally, daily. hydroxychloroquine hydroxychloroquine hydroxychloroquine

Hydroxychloroquine has been associated with ocular toxicity at therapeutic dosage. The European League Against Rheumatism (EULAR) advise not to exceed dosage of 5 mg/kg actual body weight to reduce the risk of visual lossFanouriakis, 2021. For additional considerations specific to hydroxychloroquine use, see Specific considerations for use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

For appropriate dosage in children and adolescents, see hydroxychloroquine for SLE in children and adolescents.