Reviewed by: HU Medical Review Board | Last reviewed: June 2023

During World War II, doctors discovered that the drugs used to fight malaria also helped improve the symptoms of lupus. Antimalarials specifically help with the joint pain, skin rashes, fatigue, fever, and chest pain common to lupus, and may reduce flares by up to 50 percent.1

By stopping or reducing flares, long-term use of antimalarial drugs helps slow or prevent lupus from damaging organs such as the kidneys and central nervous system. The antimalarials most often prescribed to people with lupus are:2-3

  • Hydroxychloroquine (Plaquenil®)
  • Chloroquine (Aralen®)

Hydroxychloroquine is prescribed the most often because it is thought to have the fewest side effects. Chloroquine is prescribed when hydroxychloroquine cannot be used.

How do antimalarials work on lupus?

Antimalarials help control lupus symptoms, especially skin rashes, mouth ulcers, and joint pain, but also help with inflammation and sun sensitivity. The exact mechanism of hydroxychloroquine in treating lupus is not known. It has anti-inflammatory and immunomodulatory effects that are attributed to possibly reducing cytokine production. These drugs may also help lower blood glucose and cholesterol in some people with lupus. It may also help prevent blood clots in people with antiphospholipid syndrome.2-3

Antimalarials are prescribed along with steroids and other medications, often to reduce the number of steroids required to control your flares. These drugs may take one to three months to make a noticeable difference in your lupus symptoms. You may need to take extra steroids to improve your symptoms until the antimalarials begin to work.

When lupus becomes more severe, antimalarials may not be enough to prevent complications in the kidneys, nervous system, or cardiovascular system. In these cases, immunosuppressants may be added to reduce the chances of lupus permanently damaging these organs.

Studies show that people with lupus who take antimalarials live longer than those who do not which is why many with lupus take one of these drugs for the rest of their life.1

What are the possible side effects of antimalarials?

Most of the side effects of taking antimalarials are mild with 90 percent of people saying they felt no side effects. For those that do experience side effects, most go away once your body adjusts to the medicine. The most common side effects include stomach upset, rashes, loss of appetite, and changes in skin color. Less common side effects include headache, dizziness, mood changes, and weakness. It may help to take your antimalarials with food to reduce nausea and other stomach irritations.1

It is a rare complication, but hydroxychloroquine taken long-term may damage the retina of the eye. That is why your doctor will order a baseline eye test with an ophthalmologist (eye doctor) within one year of starting the drug and then every year after 5 years. However, some ophthalmologists may prefer to screen you more often based on your risk factors.2-3

If proper screening is done, the damage should be detected well before any symptoms such as loss of vision occur.

These are not all the possible side effects of antimalarials. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with antimalarials.

Are antimalarials safe to take during pregnancy?

Unlike some other autoimmune conditions, lupus flares are more common during pregnancy. That is why doctors recommend that pregnant women continue to take antimalarial drugs as prescribed. Doctors have given pregnant women antimalarials for decades without negative side effects on the unborn baby.3

Other things to know about antimalarials

Here are a few other helpful tips about antimalarials:

  • Antimalarials are also prescribed for rheumatoid arthritis and Sjogren’s syndrome, two other autoimmune diseases that people with lupus sometimes have.
  • Smoking reduces the effectiveness of antimalarials so you should not smoke when taking them.
  • If you stop taking your antimalarials suddenly you may experience a lupus flare.

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