One such commonly used medication for dermatologic and rheumatologic inflammatory conditions is hydroxychloroquine (Plaquenil), a chloroquine derivative. It is used to treat many diseases including malaria, rheumatoid arthritis and systemic lupus erythematosus. Skin cancer side effect of plaquenil What happens is you mix hydroxychloroquine with alcohol Screening guidelines were updated this year, with some pertinent changes for our profession to note. Cumulative dose is no longer a risk factor, but more of a tool in the screening of our patients. A review group convened by the Royal College of Ophthalmologists has updated guidelines on screening for chloroquine and hydroxychloroquine retinopathy Hydroxychloroquine and Chloroquine Retinopathy Recommendations on Screening 2018. Recent data have highlighted that hydroxychloroquine retinopathy is more common than previously reported. Currently, one of the primary functional screening tests recommended for the evaluation of Plaquenil retinal toxicity is 10-2 white stimulus automated visual fields; however, research shows Asian patients benefited from 24-2 or 30-2 visual fields, given that toxicity often manifests changes beyond the macula in these patients. 9 Because spectral-domain optical coherence tomography SD-OCT is readily accessible and able to detect early structural damage prior to clinical funduscopic findings. It is imperative that patients and physicians are aware of and watch for this drug’s ocular side effects. Retinal toxicity from hydroxychloroquine is rare, but even if the medication is discontinued, vision loss may be irreversible and may continue to progress. Plaquenil retinal screening guidelines Quick Reference Screening for Chloroquine., HYDROXYCHLOROQUINE SULFATE Drug BNF content published by NICE Is hydroxychloroquine sulfate an immunosuppressive drugChloroquine phosphate lethal Kidney and liver disease predispose to hydroxychloroquine toxicity due to impaired clearance of the drug. Old age is hypothesized to contribute to overall risk due to the natural aging process of the retinal pigment epithelium RPE, causing the RPE to be more sensitive to toxic drugs. Hydroxychloroquine toxicity - EyeWiki. How to Succeed in Plaquenil Screenings. Hydroxychloroquine And Chloroquine Screening 2016 AAO.. Although it is not possible to predict which patients will develop retinal toxicity, high-risk characteristics include the following daily dose greater than 400 mg or, in people of short stature, a daily dosage over 6.5 mg/kg ideal body weight or total cumulative dose of more than 1,000 g. Multifocal Electroretinography mfERG Vision Testing. Multifocal ERG has been recognized as an effective test in helping doctors to diagnose and manage diseases affecting the retina, most notably retinal toxicities. 1-3 This visual electrophysiology technique is a test of localized retinal function through quasi-simultaneous stimulation of different areas of the retina. 4 The American Academy. Patients taking Plaquenil should have an early baseline assessment of visual acuity, macular appearance and central field sensitivity. The macular appearance and function should be checked at intervals of 6 to 12 months.