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. Chloroquine high creatinine Allegra and plaquenil The maximum safe dose is 5 mg/kg of actual body weight. For example, a patient who weighs 175 lb would be at a threshold dose when taking 400 mg daily. Screening interval has also been updated. All patients will need a baseline screening before or within 1 year of initiation of hydroxychloroquine. 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. 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. 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 Hydroxychloroquine Plaquenil Toxicity and Recommendations., AMERICAN COLLEGE OF RHEUMATOLOGY Plaquenil and pregnancy risk 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. Chloroquine DermNet NZ. Hydroxychloroquine toxicity - EyeWiki. Recommendations on Screening for Chloroquine and.. The American Academy of Ophthalmology’s recommendations for screening of chloroquine CQ and hydroxychloroquine HCQ retinopathy were published in 2002. The new guidelines also recommend that in addition to 10-2 automated fields, at least one of the newer objective tests be used, such as multifocal electroretinogram, spectral domain. 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. 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 the medication, the higher the risk of toxicity.