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. Lupus like illness normal blood work plaquenil effective Sarafen and plaquenil Plaquenil story on cbs tonight 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. One reaches a cumulative dose of 1000 grams 1 kilogram at 7 years when taking the most commonly prescribed dose of 400 mg a day. A new study then focused on those patients that had taken HCQ over 5 years. This study revealed a much higher overall risk of 7.5% retinal toxicity among the 2361 patients studied. A cumulative dose that increases the risk of retinal toxicity • 1000g total Hydroxychloroquine HCQ • 460 g total Chloroquine CQ Cumulative dose of 1000g HCQ is reached in 7 years with the daily dose of 400mg19 Cumulative dose of 460g CQ is reached in 5 years with the typical daily dose of 250mg19 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 retinal toxicity dose Retinal Toxicity in Patients Treated With Hydroxychloroquine., Chloroquine And Hydroxychloroquine Toxicity - StatPearls. Plaquenil long term use side effectsPlaquenil and intestinal problemsDoes plaquenil suppress immune system further in an immunosuppressed personCan plaquenil cause vasculitis Chloroquine Major Avoid coadministration of hydroxychloroquine and chloroquine due to therapeutic duplication as well as increased risk of retinal toxicity, QT prolongation, and torsade de pointes TdP. Hydroxychloroquine prolongs the QT interval. Plaquenil hydroxychloroquine sulfate dose, indications.. Early Plaquenil Toxicity Detected without Bull’s Eye Maculopathy. Determine risk for hydroxychloroquine retinal toxicity.. Although it is not possible to predict which patients will develop retinal toxicity, high-risk characteristics include the following daily dose greater than 400 mg or, in people of short stature, a daily dosage over 6.5 mg/kg ideal body weight or total cumulative dose of more than 1,000 g medication use longer than five years Several recent studies have shown that instead of the classic perifoveal changes typical of hydroxychloroquine toxicity, Asians with retinal toxicity have a more peripheral pattern. The dose risk is calculated by REAL weight. Previous recommendations were based on ideal body weight, which is calculated solely on patient age, height, and sex 5. The majority of cases of retinotoxicity have occurred in patients that have had a cumulative dose exceeding 1000g of hydroxychloriquine Plaquenil. This level is reached in about 7 years with the most common daily dose of Plaquenil, 400 mg/day 200 bid.