For patients

Hydroxychloroquine

Plaquenil, HCQ, antimalarial

Are you a clinician? See the clinical version of this page.

The short versionHydroxychloroquine is one of the few rheumatic disease medicines that is usually continued right through pregnancy and while breastfeeding. For many people with lupus, staying on it is actively recommended, because stopping can let the disease flare. Do not stop it on your own; confirm your own plan with your rheumatologist.

Staying on hydroxychloroquine lowers the chance of a lupus flare during and after pregnancy.
The usual dose in pregnancy is up to 400 mg a day. That ceiling is about protecting your eyes over the long term, not about the baby.
If you carry anti-Ro/SSA antibodies and have had a baby with heart block before, hydroxychloroquine lowers the chance of it happening again.
It may also lower the chance of some pregnancy complications, though the evidence for that is less certain.

Through your pregnancy journey

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Before pregnancy

Usually continued while you plan and try for a pregnancy. In lupus, being established on it before you conceive is linked to better outcomes.

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First trimester

Usually continued. At the usual dose of up to 400 mg a day, the largest study found no increase in birth defects. At doses of 400 mg a day or more, it found a small increase in birth defects overall. Looking at particular defects across all doses, that same study found more cleft lip or palate and more urinary tract defects, but these rested on very small numbers, and a later, more detailed study found no increase at all. These problems remain uncommon either way. The study's own authors said their finding should not by itself change the decision to treat. Guidelines still advise staying on hydroxychloroquine, because stopping can let your disease flare. If the dose concerns you, talk to your team about the dose rather than stopping the medicine.

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Second & third trimester

Usually continued through to delivery.

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Breastfeeding

Considered compatible with breastfeeding; only small amounts pass into milk.

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For fathers-to-be

Considered compatible for fathers-to-be; no evidence it affects fertility or the baby.

iThis page helps you prepare a conversation with your care team. It does not replace individual medical advice. Always confirm your own plan with your rheumatology and pregnancy team.

When to call your team

Do not stop hydroxychloroquine on your own; talk to your rheumatology team before making any change.
Call your team if you think you are pregnant or are planning to conceive, so your plan can be reviewed.
Seek urgent care for the red-flag symptoms listed on your condition page (for example severe headache, visual changes, or reduced baby movements).