Plaquenil and Rabies

General Medications
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How’s that for an interesting topic, eh? Long story short, I had a close call at work the other day and am seriously looking into getting a pre-exposure rabies vaccination (which I should have done years ago, to be honest). In my research on the vaccine, I learned that hydroxychloroquine can affect the efficacy of the vaccine. Naturally I just started taking hydroxychloroquine about two weeks ago. Apparently the intramuscular rabies vaccine is unaffected, but it is also not currently approved for use in the US where I am located. The half-life of hydroxychloroquine seems to be pretty long, and I need the rabies vaccine series sooner rather than later. It’s a long shot, but maybe we have some veterinarians or world travelers on here that might know; does anyone know how long I have to stop taking plaquenil for prior to receiving a pre-exposure rabies vaccine? I’m having a hard time finding info online.

Much to my surprise, I have had significantly decreased joint pain shortly after my doctor decided to double the dose of plaquenil to 400 mg/day. I would be disappointed to have to stop the trial for X days prior to the first vaccine administration and an additional 3/4 weeks during the rest of the vaccine series, because so far plaquenil seems promising. I guess I need to talk to my doctor about an alternative (sulfasalazine seems to be okay) or I’ll just have to suck it up and deal with the pain for a while.

On a side note, I have noticed increased fatigue since doubling the dose of plaquenil (specifically, crippling fatigue that often puts me in bed by 6-7 PM in the evening), which seems to be opposite the experience that a fair amount of folks online have reported. It could be coincidence (it’s pretty early for me to jump to any conclusions about the drug), but I am curious if anyone else has experienced increased fatigue with plaquenil.

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I can’t help on the rabies issue. But I can tell you I’m on sulfasalazine. Was utterly terrified to try it given its nausea side effect. But I got just no side effects at all. And sadly it doesn’t seem to be doing anything positive either. I’ve been on it since June. I’m now on 5 tablets a day and about to increase to 6. But it doesn’t do much. If I drop the naproxen and tramadol presently I’m stuck on the sofa. Next rheumy appoint is mid November and I was told to wait till then so as to meet the NICE protocol in the UK to get to the next tier of drugs.

However there are serious travellers on here so hopefully one will know a bit more about the rabies issue.

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Ok, I’m going to put my hand up as a serious traveler.

I understand you work in environmental science - you may not be traveling, but for all purposes and intents, you spend much of your time in the middle of BF nowhere.

And you were talking about working in the arctic (or was it Antarctica-same for the purpose of this discussion).

So… you need to have a discussion with your Rheumy asap on ALL immunisations. There are a few, that should you go onto biologics, you simply can’t have (because they are live - yellow fever, JE etc). With taking things like plaquenil, you may be able to (pending discussion with your Rheumy). The thing is, most of these live vaccines last for a REALLY long time. I’m still relying on my yellow fever and JE from 1999.

So it is really smart to get yourself vaccinated for anything and everything now - because - what if? You have said you are young and ambitious, it’s not beyond the realms of possibility that next year you’ll be working in India, or South America, or West Africa.

It’s also not beyond the realms of possibility that you’ll be on a biologic - and the choice may be to go off it, get your immunisations, and not be able to do your job (properly, if at all) for 3 months, or say no to that opportunity in India.

Back to the rabies though… my understanding is that rabies is not a live vaccine. In theory, then, the worst thing that could happen if you have it whilst on plaquenil is that you won’t mount an appropriate immune response, and hence will not develop immunity as others would.

To be honest, this should be assumed for the lot of us. But with Rabies, there is actually an immunity test to see how well it has stimulated your immune system. So theoretically you could skip off to your regular doc tomorrow, get the series, do the check, then if it doesn’t take, decide with your Rheumy what to do. I wouldn’t encourage that though - given your career, lifestyle, and age, having a good discussion with your Rheumy and getting a strategy on immunisations for everything possible is really a good move.

I know when I was in West Africa feeling like death, I was rather glad my chances of hep B, TB, Yellow Fever, or Rabies were really low! (I had a friend who got Hep B there - interesting experience).

It was only Salmonella - it took me 12 hours to figure it out, I had antibiotics for it with me, treated it myself, 48 hours later I was fine (detected when I got back to Aus because they were screening because I was really ill - this time with Dengue). I was taking a combination of Humira, Methotrexate, and Prednisone at the time I got the Salmonella (pretty much guaranteed to decimate the immune system) - but being prepared and knowing more or less what I had, I was fine.

The point is, if I hadn’t been able to exclude the Hep B and other options, I might not have got to the antibiotics as quickly, and the outcome may have been very different.

Talk to your Rheumy if you can, and if that will take too long, and you trust your PCP, that is the next best thing :blush:

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Thanks, Jen, you make some good points about getting vaccinated for just about everything right now. I don’t travel for work but would like to travel for fun in the future (Africa is on the near future list if I get joint pain under control). Rabies is urgent because I handle wildlife for my job; it’s more a matter of when than if. I’m careful but I make mistakes, and if I had an active rash on my hand with broken skin just a few days earlier like I do this morning, I’d be forking over tens of thousands of dollars for post-exposure treatment (yes me, not my employer because they found a loophole for worker’s comp).

The good news is that my insurance is awesome and would cover everything, even pre-exposure rabies which is very expensive. But I can’t afford for the vaccine to fail to take because then my insurance company might not pay for a second chance.

I’ll get on it with my primary doctor right away (the rheum would probably not be helpful–she hasn’t been thus far and would probably just laugh at the suggestion that I could ever have to be on more serious medication). I’ll be sure to discuss future travel plans/dreams to explore what else I should be thinking about. Thanks!

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Looks like I may have gotten it backwards… intramuscular rabies vaccine is administered in the US, but not interdermal. So I may have nothing to worry about after all, so long as I get the titers checked.

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The power of BF… A corporate geologist and an environmentalist working together… LOL

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Haha, corporate geologists ought to be thanking us environmental scientists for the amount of gasoline we burn through doing our research! Never did I imagine how much time I would spend driving (or operating other gas-powered vessels) while doing conservation work. PS, for the record, I’m all for working together and multiple, sustainable use of environmental resources.

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As long as you guys don’t come up with a replacement for Indium and gallium in solar panels I’ll be happy. I have some now worthless ranch land in the Montana Western Phosphate Field which ranges from southern Montana to northern Utah. Worthless because of the loss of my ground water which has been replaced by saline seep… from fracking to power those vehicles. But a Gallium mine, I might be able to retire after all. Cant’ hunt sage grouse anymore though

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0001_11

I have far more knowledge about these guys than I do solar panels and geology, so your solar panels are safe from me.

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Loving that picture @Weasel.

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Wish I understood more Bout them. When I was kis they were so thick, they were actually a nuisance (and made pheasants hard to find) I’m convinced it has to with the demise of dryland farming (oh how I hated summer fallowing) and the increase in irrigation and the subsequent spraying of ammonia…

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What Weasel said :grinning:

Besides @tntlamb, my last corporate job was actually as the Sustainability Manager!

Glad to be in minerals though. A visible hole is ugly, but at least it SHOULD be fairly easy to design and manage to keep the “ugly” relatively local and prevent any widespread habitat destruction (if everyone does their job well - Unfortunately there are some bad examples where they didn’t, especially in the tailings dams).

Can’t see fracking ending well for anyone though. I’m very happy not to have to be a part of that (and it’s one spot where Australia is finally showing just a little caution and not following the US at great speed).

Gallium you say? Perhaps if I ever get there I can tax-deduct part of my trip!

Anyway, I digress…

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But its nice to pull the chains a couple great scientists from time to time… and Frankly I am very concerned about Sage Grouse. Montana was so thrilled to get rid of Zinke as congressman, we never even though he’d ride his horse into the Department of Interior Raise his Royal crest Flag (really) and screw things up there too…(proving once again the Peter Principle)

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Yeah, I knew you were after a reaction, thought to myself that if the best thing I can do around here is to provide some entertainment, who am I to deny you that? :joy::joy:

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Thanks. Taken back when I was wreckless enough to take my fancy (now outdated) camera to work. Haven’t picked up my camera in a long time now; I’ll get the motivation again once of these days.

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