Chloroquine dosage ophthalmology guidelines

Discussion in 'Northwest Pharmacy Canada' started by xiva, 24-Feb-2020.

  1. nigmas Well-Known Member

    Chloroquine dosage ophthalmology guidelines


    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.

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    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

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  4. 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.

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    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.

     
  5. Stique Well-Known Member

    400-600 mg (310-465 mg base) PO daily for 4-12 weeks; maintenance: 200-400 mg (155-310 mg base) PO daily With prolonged therapy, obtain CBCs periodically 400 mg (310 mg base) PO once or twice daily; maintenance: 200-400 mg (155-310 mg base) PO daily With prolonged therapy, obtain CBCs periodically 100-200 mg (77.5-155 mg base) PO 2-3 times/wk Take with food or milk Nausea, vomiting Headache Dizziness Irritability Muscle weakness Aplastic anemia Leukopenia Thrombocytopenia Corneal changes or deposits (visual disturbances, blurred vision, photophobia; reversible on discontinuance) Retinal damage with long-term use Bleaching of hair Alopecia Pruritus Skin and musculoskeletal pigmentation changes Weight loss, anorexia Cardiomyopathy (rare) Hemolysis (individuals with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency) Prolongs QT interval Ventricular arrhythmias and torsade de pointes Vertigo Tinnitus Nystagmus Nerve deafness Deafness Irreversible retinopathy with retinal pigmentation changes (bull’s eye appearance) Visual field defects (paracentral scotomas) Visual disturbances (visual acuity) Maculopathies (macular degeneration) Decreased dark adaptation Color vision abnormalities Corneal changes (edema and opacities) Abdominal pain Fatigue Liver function tests abnormal Hepatic failure acute Urticaria Angioedema Bronchospasm Decreased appetite Hypoglycemia Porphyria Weight decreased Sensorimotor disorder Skeletal muscle myopathy or neuromyopathy Headache Dizziness Seizure Ataxia Extrapyramidal disorders such as dystonia Dyskinesia Tremor Rash Pruritus Pigmentation disorders in skin and mucous membranes Hair color changes Alopecia Dermatitis bullous eruptions including erythema multiforme Stevens-Johnson syndrome Toxic epidermal necrolysis Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) Photosensitivity Dermatitis exfoliative Acute generalized exanthematous pustulosis (AGEP); AGEP has to be distinguished from psoriasis; hydroxychloroquine may precipitate attacks of psoriasis Pyrexia Hyperleukocytosis Hypersensitivity to 4-aminoquinoline derivatives Retinal or visual field changes due to 4-aminoquinoline compounds Long-term therapy in children Not effective against chloroquine-resistant strains of P. Individual plans may vary and formulary information changes. Mechanisms of action of hydroxychloroquine and chloroquine. Hydroxychloroquine Information for Providers AIDSinfo RA and Hydroxychloroquine How Effective is it for.
     
  6. scan Moderator

    Plaquenil is the brand name for the prescription drug hydroxychloroquine. Hydroxychloroquine Oral Route Side Effects - Mayo Clinic Long-Term Side Effects of Plaquenil for Rheumatoid Arthritis. Plaquenil Oral Uses, Side Effects, Interactions.
     
  7. ashotius XenForo Moderator

    On the Mechanism of Chloroquine Resistance in Plasmodium. Resistance to chloroquine of malaria strains is known to be associated with a parasite protein named PfCRT, the mutated form of which is able to reduce chloroquine accumulation in the digestive vacuole of the pathogen. Whether the protein mediates extrusion of the drug acting as a channel or as a carrier and which is the protonation state of its chloroquine substrate is the subject of a.

    Antimalarial Drug Mechanism of Action What is Chloroquine?