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. Plaquenil blurry vision Chloroquine davis Dr bhat plaquenil 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. Therefore, disturbed renal or hepatic function might reduce HCQ clearance and increase the propensity for toxicity. A woman aged 28 years with systemic lupus erythematous and abnormal kidney function, treated with 45 mg/kg hydroxychloroquine daily for 15 years cumulative dose 1369 g, presented with bilateral progressive central vision loss for 2 months. The patient had no known previous exposure to chloroquine. Best corrected visual acuity was 20/40 in her right eye and 20/30 in her left eye. Funduscopy. The number of reported cases of likely toxicity begins to increase sharply after approximately 5 years of use. 10 A cumulative dose of 1000 g HCQ is reached in 7 years with a typical daily dose of 400 mg, and a cumulative dose of 460 g CQ is reached in 5 years with a typical daily dose of 250 mg. 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. Chloroquine maculopathy cumulative dose Chloroquine retinopathy - Wikipedia, Hydroxychloroquine-induced bull's eye maculopathy - The. Chloroquine price philippinesPlaquenil eye risksSelenium and plaquenil Cumulative dose 1000 g total HCQ 460 g total CQ Daily Dose Hydroxychloroquine HCQ Chloroquine CQ 400 mg/day 6.5 mg/kg ideal body weight for short individuals 250 mg/day 3.0 mg/kg ideal body weight for short individuals Age Elderly Systemic disease Kidney or liver dysfunction Ocular disease Retinal disease or maculopathy Early Plaquenil Toxicity Detected without Bull’s Eye.. Revised Recommendations on Screening for Chloroquine and.. Bull's-eye maculopathy due to hydroxychloroquine toxicity. The recommended adult dosage is 200 to 400 mg 155 to 310 mg base daily, administered as a single daily dose or in two divided doses. Doses above 400 mg a day are not recommended. The incidence of retinopathy has been reported to be higher when this maintenance dose is exceeded. Nov 01, 2015 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. Therefore, disturbed renal or hepatic function might reduce HCQ clearance and increase the propensity for toxicity. Feb 27, 2019 The retinopathy is related to the total cumulative dose and is more marked with chloroquine. Patients present with decreased vision which may be severe in end-stage chloroquine maculopathy - less than 6/60 - and characterised by a 'bull's-eye' macular lesion a well-defined red centre surrounded by a mottled yellow periphery, abnormal colour.