Hello halfpint
The answer is slightly different depending on whether you mean lowering or raising the dose and by how much. Plaquenil is an essential disease modifying drug. By changing the Ph balance of the cells it inhibits further antibody formation thus helping stop disease progression and reducing flares.
By reducing inflammation it can naturally reduce symptoms too especially skin, arthritis/ arthralgia, fatigue and serositis.
Lumping the three antimalarials altogether, although each has some slightly different properties, they appear to have numerous beneficial side effects too: anti- inflammatory, reducing photosensitivity, reducing cholesterol and osteoporosis, reducing fevers, antiplatelet and antithrombotic, antiviral, antifungal, steroid dose reducing, even reducing incidence of diabetes in a recent study. Studies as well as anecdotal evidence show clear evidence of worsening of disease when the dose is lowered or the drug stopped.
If the dose is increased beyond the usual therapeutic maximum of 400 mgs a day( 6.5 mgs per kilo or 3 mgs per lb of ideal body weight) the risks of retinal toxicity increase with time, as it is cumulative, and in certain groups of patients, for example the overweight, well,that horrid word, obese. Many doctors prefer to add a drug like methotrexate, imuran or cellcept than increase the Plaquenil depending on their estimation of the patient's needs and what would suit them best. It's also unlikely that an increase in Plaquenil would be all that much more effective. Each drug works in a slightly different way. If the working of the Plaquenil has maxed out, more doesn't mean still better.
Another option for greater antimalarial pow is to add Quinacrine ( UK Mepacrine) to the Plaquenil, and to get the special benefits of that drug, if it suits the case and individual patient.
All the best
Hugs
Clare
