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. A patient will begin taking hydroxychloroquine for rheumatoid arthritisi Plaquenil visual field testing Hydroxychloroquine HCQ, used widely for the chronic treatment of autoimmune disorders with minimal toxicity, is better known for its potential irreversible retinal toxicity and thus limited to a daily dose of 5 mg/kg and recommended for annual visual field and optical coherence tomography screening for retinal toxicity after the first 5 years. Sep 15, 2014 A cumulative dose of 1000g HCQ is reached in 7 years with a typical daily dose of 400 mg. In the same study, toxicity was not related to age, weight or daily dose but was related to duration of use and increased rapidly after 5 to 7 years; thus, it is important to be aware of the risk factors and use more effective protocols of screening on all the patients who exceed 5 years of exposure. Doses ≥ 5 mg/kg/day real weight of hydroxychloroquine 2.3 mg/kg/day of chloroquine are associated with higher risk of toxicity. Doses lower than 5 mg/kg/day have low risk 1% for the first 5 years, and below 2% between 5-10 years of use. The longer you use. 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). Plaquenil cumulative dose toxicity Hydroxychloroquine-related retinal toxicity Rheumatology., Retinal toxicity associated with chronic exposure to. What are the warning on the nnedicine named hydroxychloroquineMalaria prophylaxis chloroquine doseMixed connective tissue disease hydroxychloroquine 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. New Guidelines on Hydroxychloroquine Dosage - Where Are We.. Hydroxychloroquine And Chloroquine Screening 2016 AAO.. Plaquenil Dosage Guide -. Jan 05, 2020 Risk for toxicity is least with less than 6.5 mg/kg/day for hydroxychloroquine and 3 mg/kg/day for chloroquine. Patients are at low risk during the first 5 years of treatment. Cumulative use in excess of 250 grams increases the risk for toxic retinopathy. Other risk factors include obesity, kidney or liver disease, older age. Nov 01, 2015 The incidence of retinal toxicity is associated with the cumulative dose of the drug, increasing significantly beyond 1,000 g of HCQ. This cumulative dose is created when the common dose of 400 mg/day is used for 6.8 years. Hydroxychloroquine is metabolized and secreted by both the liver and the kidneys. The risk of plaquenil-induced toxic maculopathy is associated with a cumulative dose level of 1,000 grams and it usually takes 5-7 years for patients on the standard dose of 250-400 milligrams per day to reach that level.