Hydroxychloroquine Prescriptions

This information is intended to explain the difference between brands of hydroxychloroquine tablets in the UK and what you need to do if you are unable to obtain the one you need.

WHY WAS I PRESCRIBED HYDROXYCHLOROQUINE?

Hydroxychloroquine is generally the first line of treatment for someone who has been diagnosed with lupus. It is used for skin and joint involvement, muscle inflammation, fever, fatigue, pleurisy, to reduce the development of renal (kidney) disease and chronic damage, and for its steroid-sparing properties. It is one of the few licensed drugs for lupus and there is good evidence for its efficacy and safety.

When you were prescribed hydroxychloroquine your consultant will have arranged an eye examination with your ophthalmologist and this should be repeated annually after five years of consecutive treatment. This screening is to mitigate a very low risk of retinopathy.

Which brand/version is best?

Hydroxychloroquine is the name of the drug but there are a few different versions available in the UK. Plaquenil® was the original brand or trade name for hydroxychloroquine that was patented. The only other branded product is Quinoric® (produced by Bristol Laboratories). Generic versions are non-branded products (produced off patent and cheaper than the originals) that have been produced by a variety of companies since the patents for these two brand expired. Every version (with a brand name or generic version) will include the same quantity of the active ingredient hydroxychloroquine, but the formulations differ in terms of the ‘fillers’. The generic versions are sometimes know by the company that produces them: Zentiva (produced by Zentiva), Blackrock (produced by Blackrock Pharmaceuticals and Bristol (a generic version of Quinoric produced by Bristol Laboratories).

There isn’t a particular brand of hydroxychloroquine tablet that will be best for every individual with lupus. It must be remembered that all people with lupus have varied presentations of symptoms and react to medications differently. It is important to find a version that suits you personally.

Why can I no longer get Plaquenil®?

Plaquenil® was the original brand of hydroxychloroquine and was previously the most commonly supplied by pharmacies in the UK. In summer 2015 Sanofi-Aventis Medicine (the manufacturers of Plaquenil®) ‘de-branded’ the drug to generic. This meant that Plaquenil® branded hydroxychloroquine was no longer available but the Zentiva generic version is made identically to the original Plaquenil®.

Any prescriptions that stated ‘hydroxychloroquine sulfate 200mg (Plaquenil)’ or ‘hydroxychloroquine sulfate 200mg’ can be supplied by whichever version the pharmacist has available as Plaquenil® is no longer available by that name.

Why can I no longer get Teva hydroxychloroquine

In April 2019 Teva UK Limited discontinued supply of their 200mg hydroxychloroquine tablets. We have been provided with the following statement;

"We constantly review our product portfolio and look at the products that sit within it. This is something we do routinely and the decision to discontinue any product is made only where necessary, due to supply and demand. Please accept my apologies once again as we do fully understand the importance of all of our products to patients and this decision is never made lightly."

The Teva version of hydroxychloroquine was made for Teva by Blackrock, and was identical to the Blackrock hydroxychloroquine tablets. If you tolerated the Teva version of hydroxychloroquine better than others, we would recommend you discuss with your doctor that the Blackrock version may be a sensible/reasonable alternative.

I’ve heard some people react badly to Quinoric®?

There is evidence indicating that that many experiences of adverse effects are related to the Quinoric® branded hydroxychloroquine tablets which was published in The Journal of Rheumatology - ACCESS HERE. The most frequently reported adverse effect from Quinoric® is gastrointestinal upset including nausea.

It should be noted that this is not the experience of all lupus patients taking this particular brand of hydroxychloroquine. If you take the Quinoric® brand and experience no adverse effects then there is no reason to request a change to another brand.

What should I do if I have experienced side effects from hydroxychloroquine?

It is important to mention any unexpected symptoms or side effects to your doctor or pharmacist as soon as possible. Some side effects go away over time as your body gets used to a new drug, so your doctor may recommend you stick with your current plan for a little longer. In other cases, they advise you to lower your dose or try a different drug. There is no clinical evidence that any specific version of hydroxychloroquine causes lupus to flare. It is worth noting that the drug takes several months to work when it is first started, during which time patients may experience lupus symptoms or flares.

Each brand of hydroxychloroquine available has a slightly different formulation. Some people with lupus report adverse effects when they take certain brands, most commonly Quinoric®. If you suspect that your side effects could be linked to the brand of hydroxychloroquine you take, you may want to consider discussing this with your doctor.

If you have experienced side effects from your hydroxychloroquine then you should report them using the Yellow Card Scheme. It is important to specify which company’s version of hydroxychloroquine you experienced the adverse reaction to, especially if a change of version has reversed these effects for you. You can lodge a report online HERE.

If you previously received Plaquenil® and know that you can tolerate it, the generic with the same formulation is Zentiva. Another alternative that you could try is Blackrock as they have different fillers to Quinoric® or generic Bristol hydroxychloroquine tablets. Please always bear in mind that people with lupus respond to drugs differently – these brands may not necessarily be more suitable for any given individual.

What if my pharmacist cannot obtain my preferred brand of hydroxychloroquine?

We have received a lot of reports from people with lupus recently that their pharmacist has been unable to dispense either the Zentiva or Blackrock versions. In many cases it has been suggested that this is the result of manufacturing or supply problems. There are currently no manufacturing or supply issues for these versions in the UK. We will publish additional advice if/when a manufacturing or supply issue occurs.

You can provide the information below to your pharmacist to help them obtain the version of hydroxychloroquine that you need;

Zentiva
If your pharmacist has any difficulty obtaining generic hydroxychloroquine produced by Zentiva, the product description is: "HYDROXYCHLOROQUINE SULFATE (ZENTIVA) 200MG FILM COATED" and the PIP number (product code) is 1201730. If for any reason they cannot find the product on their system they can ring the customer service line on 0844 8793 188.

Blackrock
If your pharmacist has any difficulty obtaining Blackrock generic hydroxychloroquine, the product description is: “Hydroxychloroquine Sulfate Tablets (Blackrock)”. The product information can be found at www.blackrockpharma.com. Blackrock Pharmaceuticals can be contacted at 0115 9890841 for any further information that may be required. Pharmacists can access Blackrock Hydroxychloroquine Sulfate 200mg tablets direct by quoting PIP number (product code) 1169523.

WHAT IF MY PHARMACIST REFUSES TO DISPENSE MY PREFERRED BRAND OF HYDROXYCHLOROQUINE ON THE BASIS OF COST?

We have been informed by some people that their pharmacy is either unable, or refuses to dispense either the Zentiva or Blackrock versions of hydroxychloroquine on the basis that they are more expensive than Quinoric®. We understand that it is correct that Quinoric® is the least expensive, but as these are generic medications the difference in cost per pack is minimal and is considerably cheaper than having to change to alternative medications for lupus if Quinoric® is not tolerated or the cost of additional drugs needed to treat the side-effects and the cost of investigations to assess the side effects.

Typically, if a medicine is prescribed by a generic name (i.e. ‘hydroxychloroquine 200mg’) the pharmacist may dispense any suitable generic or branded product and would be reimbursed at a set price by the NHS according to the Drug Tariff. Pharmacists would generally aim to dispense one of the less expensive products available so that they receive more profit from this tariff and avoid any potential losses.

According to UK Medicines Information (UKMi) if a medicine is prescribed specifically by company name (i.e. ‘hydroxychloroquine sulfate 200mg – Zentiva version only’) then the pharmacist may dispense only the specified brand and is reimbursed for doing so. This reimbursement is not at the set price listed in the Drug Tariff and therefore the pharmacy should not make a loss for dispensing the item. Additional information about prescribing generic medications is available HERE.



Our thanks go to Professor Caroline Gordon and Sr Rebecca Gilman (Lupus Research Clinical Nurse Specialist) for their valuable contributions to the provision of this information.

If you continue to experience any issues obtaining the hydroxychloroquine tablets that you need, please keep us updated by emailing paul@lupusuk.org.uk or calling 01708 731251.


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Last updated 02/07/2020