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How do you manage nausea in the setting of hydroxychloroquine use?

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How do you manage nausea in the setting of hydroxychloroquine use?

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1 Answer
Mednet MemberInvited Expert
Rheumatology · Uniformed Services University of the Health Sciences (USUHS)
Answered on

My method for approaching hydroxychloroquine (HCQ)-induced nausea:

  • Stop HCQ
  • When nausea is gone, restart with just 1/2 tablet every night after food or milk
    (I recall a study suggesting that nocturnal use caused less side effects, but I cannot find it. If anyone has the source, please chime in).
  • A week later, increase to 1/2 tablet twice daily after eating
  • A week later, increase to 1/2 tablet three times a day
  • A week later, increase to 1 tablet twice daily after food
  • At any point, if nausea occurs, immediately go down to the previously tolerated dose
  • Then I check a HCQ whole blood level (from LabCorp, Quest, or Exagen), aiming for a drug level of 1000 ng/mL or higher, but less than 1500 ng/mL
  • If I have a therapeutic level, then fantastic!
  • If...

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