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Plastikos Plastic & Reconstructive Surgery
4370 Georgetown Square |
PLAQUENIL
Provided by: Dr. Douglas Shanblin
Plaquenil is the trade name for hydroxychloroquine, a medication which modulates tlie immune reaction through blocking the interleukin-2 receptor. Siliconosis or silicone disease is the result of the immunopathic part of silicone implantation.
Interleukin-2 activity is not part of the direct tissue toxicity of silicone which may be a specific metabolic effect. Women with high T lymphocyte memory to silicone are sicker than those without active immune processing. Plaquenil will drop this down toward immune quiescence, and, after a sufficient period, can bring the reaction down to normal levels by which is meant no measurable excess immune activity.
Plaquenil comes in 200 mg capsules. The best use of this medication is to smooth over the immune reaction to device explantation but it also useful after surgery, even up to two or three years later. Hydroxychloroquine is freely water soluble so it takes several weeks to get an effective dose.
The best dose is 400 mg per day at one 200 mg tablets twice a day, with meals (breakfast and dinner). This is the adult dose. There is no known role for hydroxychloroquine in children with second-generation silicone disease although it is used in childhood malaria in the tropics.
If used to cover surgery it should be started three weeks before surgery and maintained for a total of 100 days (this requires two bottles each with 100 tablets, the standard formulation), 100 hundred days is the standard treatment course.
If surgery is scheduled less than three weeks after making the decision to explant so-called front loading can be done but this will require specific instructions from your doctor.
A small percentage of individuals will experience loose bowel movements for a few days while their system adjusts to the hydroxychloroquine. Two shot glasses of Peptobismol or similar medication may help with this; DO NOT TAKE the Peptobis-mol at the same time; an hour afterwards is good.
Plaquenil can be obtained in grocery store pharmacies or full service drug stores. A typical cost is about $80.00 per 100 tablets at 200 mg each. This is a fifty day supply at the typical dose. There are discount pharmacies which operate by telephone/mail order; ask your physician for assistance. The total cost for a 100 day supply is thus about $ 160.00.
If you have a lot of residual silicone it may be necessary to stop treatment for two months, and then have a second round. Hydroxychloroquine should not be taken for more than six months; it loses its effect after this. Older women may need an eye exam; the drug occasionally promotes retinal pigmentation. It is used for rheumatoid arthritis and other immune states with T cell activity.