Her rheumatologist instructed her to undergo a baseline ocular examination prior to initiating Plaquenil (hydroxychloroquine, Sanofi-Aventis) therapy. Toxic maculopathy associated with chloroquine use was first documented in the literature five decades ago.1 In the United States, Plaquenil––an analog to chloroquine––is used to treat a variety of conditions, including rheumatoid arthritis, lupus and several distinct inflammatory disorders. Although the incidence of macular toxicity is infrequent with Plaquenil use (at a dosage of 200mg or 400mg q.d.), its visual impact can be devastating. Chloroquine primaquine combination Generic vs brand name plaquenil Plaquenil and burning eyes The most recent 2016 guidelines from the American Academy of Ophthalmology AAO recommend the dose of HCQ ≤5 mg/kg real body weight to minimize toxicity 1. According to these new guidelines, the risk of HCQ retinal toxicity is less than 1 % in the first year of therapy and less than 2 % up to 10 years of therapy. In 2016, with new scientific data, the American Academy of Ophthalmology revised their screening recommendations for patients on chloroquine for longer than 1 year 5. The two most important risk factors for retinopathy are the duration of chloroquine treatment and a daily dose of chloroquine 2.3 mg/kg of the patient's actual body weight. Mar 02, 2018 The new guideline also makes recommendations regarding the techniques and timing of baseline and follow-up screening tests for both hydroxychloroquine and chloroquine retinopathy. Hydroxychloroquine is a medicine that is effective in treating various long-term inflammatory disorders of the joints and skin. Initially, central visual acuity may be unaffected, but the patient may notice related paracentral scotomas that often interfere with reading. The associated classic retinal toxicity is described as a bull’s eye maculopathy (ring of depigmented retinal pigment epithelium that spares the foveal area). Chloroquine dosage ophthalmology guidelines Recommendations on Screening for Chloroquine and., Chloroquine DermNet NZ Plaquenil maculopathy screeningSide effects of long term use of plaquenil Occurs. They should take one dose per week while there, and for 4 consecutive weeks after leaving. The weekly dosage for adults is 300mg base 500mg salt. Your doctor will have calculated the correct weekly. dose for your child based on the child’s weight. The child’s dose should not exceed the adult dose of 300mg base 500mg salt per week. Medicines for the Prevention of Malaria While Traveling.. RCOphth guideline Hydroxychloroquine and Chloroquine.. Chloroquine and Hydroxychloroquine Toxicity Guidelines.. Aug 30, 2011 A cumulative dose of 1000g of hydroxychloroquine or 460g of chloroquine was likely the largest risk factor, which was typically achieved after 5-7 years of a typical dosage 8, 10. However, there have been case reports of patients with hydroxychloroquine toxicity as early as 1.9 months after starting treatment 11. Previous 30 recommendations by the AAO to limit HCQ dosing to 6.5 mg/kg of ideal body weight have been 31 revised to 5 mg/kg of actual body weight 5. Some authors recommend 6.5 mg/kg of actual 32 body weight with a cap at 400 mg per day and further adjustments for renal insufficiency 10. Although the incidence of macular toxicity is infrequent with Plaquenil use at a dosage of 200mg or 400mg q.d. its visual impact can be devastating. 2,3. The associated classic retinal toxicity is described as a bull’s eye maculopathy ring of depigmented retinal pigment epithelium that spares the foveal area.