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Plaquenil and Green Stool in Baby

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  • Plaquenil and Green Stool in Baby

    I was recently diagnosed with RA (onset 2 months postpartum) and put on plaquenil 400mg/day so that I could continue to breastfeed my baby. I also was given prednisone, which I started a few weeks before taking plaquenil and am now on 5mg prednisone/day. Ever since I started taking plaquenil (2 200mg tablets in the morning with food), my baby's stools have been a distinct shade of green. He is otherwise healthy and behaving normally. There have been no other changes in my diet since I started taking plaquenil. Does this mean the baby is reacting badly to the plaquenil? Would you recommend changes in the time/method of my taking the medicine or discontinuing its use? I really want to continue nursing but don't want to harm my baby's health. Thank you so much for your work in this field.

  • #2
    Hi, thanks for your post.

    I consulted with Dr. Hale on this one and we can't come up with a plausible connection between the hydroxychloroquine and the green stool. This effect has not been documented anywhere in the literature or the manufacturer's published information. Of course, we can't prove it's not the med. If your baby has no other symptoms, I would not change your breastfeeding schedule until you have more information. Consult with your pediatrician to see if he/she has any ideas.

    Judging from the most common side effects seen in adults, I would expect the most likely side effects in babies to be vomiting, loss of appetite, poor weight gain, irritability, muscle weakness, or anemia. Without a clear indication of one of these, I think the green stool is pretty unlikely to be because of the medication. Let me know what your pediatrician has to say.

    Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519

    -James Abbey, MD

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    • #3
      Thank you, Dr. Abbey for your prompt reply. I spoke to the pediatrician and two rheumatologists. They all echoed your opinion. The pediatrician said the best information on the effect of plaquenil in lactation is that it is "probably safe" and that if all else is fine with the baby, there is no need to change course. The two rheumatologists also recommended I stay on the medicine, noting it is safe for lactation. One rheumatologist did not think the green stools are related to the plaquenil. My gut feeling is that the plaquenil is causing the change since all else is the same. Fortunately, the baby seems otherwise unaffected. I noticed on a babycenter website blog that two other women reported the same green poop in their babies while on plaquenil but those posts were from 2012.The two remaining questions I have are 1 ) whether you would recommend I wait two hours or so after I take the plaquenil before I nurse; And 2) whether you believe I should get my infants retina examined. Thanks much again.

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      • #4
        It is probably not necessary to wait the 2 hours before feeding. In fact, our information suggests that that is about how long it takes to be digested and reach its *maximum* concentration in the milk. You are better off nursing/pumping just before or just after you take your dose.

        A recent study re-examined the incidence of retinopathy in patients prescribed hydroxychloroquine and found it to be around 0.5%. Furthermore, the risk appears to be dependent on the dose and the length of treatment. Only a single case has been reported of someone developing problems earlier than the 6th year of treatment. Current guidelines are that increased frequency of retinal exams are not necessary for people taking this drug for <6 years. Your baby only gets around 3% of your daily dose through the milk and I would expect that his/her risk of retinopathy would be proportionally less.

        Please call us at the InfantRisk Center if this has not completely answered your question. (806)352-2519

        -James Abbey, MD

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        • #5
          As an update, I switched to the brand name plaquenil and my baby's stools are now back to yellow.

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          • #6
            It is very important for newborn baby. It is beneficial for baby health & create energy. breast feeding for baby is more powerful than all tonics.

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            • #7
              `

              Yes you are absolutely right.

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              • #8
                I think your decision is right because breastfeeding is the best food than all kind of foods,

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