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. Cpt code plaquenil screening Plaquenil and glutamate Dosage levels that can cause toxicity 6.5 mg/kg Hydroxychloroquine Plaquenil19 3 mg/kg Chloroquine Arlen With Plaquenil Plaquenil is manufactured in only a 200 mg tablet The typical dosage is either 200 or 400 mg per day 200 mg daily puts anyone under 68 pounds at risk1 Symptoms of Plaquenil toxicity are similar to other macular problems and may include Decreased fine vision or difficulty reading. Changes in Color vision. Missing Spots or shadows near the center of the vision. Ocular manifestations of hydroxychloroquine include corneal verticillata and retinal toxicity. Verticillata are cornea deposits of salts within the corneal epithelium. This condition does not cause symptoms and is reversible with cessation of the medication. 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 macular toxicity Has anyone experienced plaquenil toxicity with damage to eyes?, Plaquenil Toxicity Screening - Retina Group of New York Chloroquine hypnozoitesHydroxychloroquine blurred vision due toChloroquine interfer nucleic acid biosynthesis Her ocular history was remarkable for Plaquenil hydroxychloroquine, Sanofi-Aventis macular toxicity. Her systemic history was significant for lupus, which was initially diagnosed 15 years earlier. For the last 14 years, she took 400mg Plaquenil QD. At her last visit, we instructed the patient to discontinue medication use. Is Damage Still Occurring? - Review of Optometry. Hydroxychloroquine Plaquenil Toxicity and.. New Plaquenil Guidelines. A risk factor for Plaquenil hydroxychloroquine retinotoxicity is a daily dose that exceeds 5.0 mg of drug per kg of body weight. The tool on the right simply calculates this threshold based on a ppatient’s real body weight. It’s important to understand that the daily dose is only one risk factor for plaquenil retinotoxicity. Dec 04, 2014 The incidence of HCQ retinopathy is very low. In fact, HCQ is estimated at having a 0.5% incidence of retinal toxicity after 5 years of therapy.5,6 Retinal toxicity secondary to HCQ is irreversible and can continue to progress following cessation of therapy. Prompt screening and serial monitoring, with the utilization of imaging modalities, is paramount importance to early detection. Risk factors for toxicity. Reported risk factors for toxicity include daily dose 400 mg, or 6.5 mg/kg ideal/lean body weight for short individuals; cumulative dose 1000 g; duration of use 5 years; renal or hepatic dysfunction; obesity; age 60 years; and pre-existing retinal disease or maculopathy 31.