She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Chloroquine and hydroxychloroquine rheumatoid arthritis Treating psoriatic arthritis with plaquenil Chloroquine 250mg Characteristics of individual patients screened for possible hydroxychloroquine HCQ retinopathy Duration, Daily HCQ Total HCQ Daily HCQ Patient Age Raceisex* Diagnosis? years dosage, rng dose, grn dosage, mgikg 1 48 WIF SLE 7.3 400 1,066 6.98 2 77 WIF RA, TIA 3.5 400 511 6.82 3 69 WIF RA 4.8 200 343 3.44 May 16, 2011 Hydroxychloroquine Plaquenil; HCQ has been an important and effective drug for the treatment of lupus erythematosus and related autoimmune and inflammatory diseases for half a century, although its potential to cause retinal damage continues to raise concern among rheumatologists and ophthalmologists. Medication Dosage. Several factors have been associated with the risk of developing hydroxychloroquine retinopathy. One of the most important appears to be dosage—with debate over whether daily intake vs. cumulative dosage is most significant. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Hydroxychloroquine retinopathy dose Hydroxychloroquine Blood Level Testing May Predict., Hydroxychloroquine Retinopathy Still Alive and Well - The. Hydroxychloroquine monitoring guidelines Retinopathy is rare with hydroxychloroquine when used at currently recommended doses 6.5 mg/kg/d, but increases markedly towards 1% after 5–7 years of usage or a cumulative dose of 1000 g of hydroxychloroquine. 257,258 The risk with chloroquine is thought to be significantly greater, with an increased risk at over 460 g chloroquine. In. Chloroquine Retinopathy - an overview ScienceDirect Topics. Hydroxychloroquine-Induced Retinal Toxicity - American.. Hydroxychloroquine Dosage Guide with Precautions -. These changes bear no relationship to dosage and are usually reversible on cessation of hydroxychloroquine. The macular changes are potentially serious. Advanced retinopathy is characterized by reduction of visual acuity and a "bull's eye" macular lesion which is absent in early involvement. Interactions The incidence of retinopathy has been reported to be higher when this maintenance dose is exceeded. Rheumatoid Arthritis. Following a single 200 mg oral dose of PLAQUENIL to healthy male volunteers, the mean peak blood concentration of hydroxychloroquine was 129.6 ng/mL, reached in 3.26 hours with a half-life of 537 hours 22.4 days. Mar 08, 2017 Based on the 2011 recommendations from the AAO and ACR, 17% of the patients were receiving an HCQ overdose that was more than 10% above the recommended dosage, and another 13% received a smaller overdose. If the 2016 dosage guidelines were applied, the extent of overdosing might be even greater, Dr. Koppikar said.