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. Plaquenil ingredients Chloroquine high creatinine Hydroxychloroquine. Take monitoring booklet every time the patient sees the GP, has a hospital appointment or visits the pharmacist. Secondary care review During initiation 4 – 6 weekly until controlled Once disease controlled Annual review by consultant Availability 200mg tablet 60 = £5.15 Prices from November 2011 Drug Tariff Hydroxychloroquine Plaquenil is considered a disease-modifying anti-rheumatic drug DMARD. It can decrease the pain and swelling of arthritis. It may prevent joint damage and reduce the risk of long-term disability. Hydroxychloroquine is in a class of medications that was first used to prevent and treat malaria. The new guideline on screening for hydroxychloroquine and chloroquine retinopathy is written in response to evidence from the United States that shows that hydroxychloroquine retinopathy is more common than previously recognised. Implementation of the guideline’s recommendations will prevent iatrogenic visual loss. The new guideline also makes recommendations regarding the techniques and. 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). Hydroxychloroquine monitoring requirements Summary of Monitoring Requirements for Medicines used in., Hydroxychloroquine Plaquenil Chloroquine retinal cellPlaquenil flying saucerVortex keratopathy plaquenilPlaquenil empty stomachPlaquenil retinopathy oct images The amount of monitoring with hydroxychloroquine varies from centre to centre. More frequent surveillance is needed if laboratory values are abnormal or with high-risk patients. The patient's full blood count, renal function, and liver function should be examined at baseline, then checked periodically. Hydroxychloroquine DermNet NZ. RCOphth guideline Hydroxychloroquine and Chloroquine.. Recommendations on Screening for Chloroquine and.. Since the initial screening and monitoring recommendations were published in 2002, there have been reports of retinal toxicity associated with the use of Plaquenil. Furthermore, the advent of novice sensitive diagnostic modalities has led to a revision of the recommended guidelines for patients using Plaquenil see “2011 Plaquenil Screening. For information and support call 0300 3030 111. Hydroxychloroquine is a medication used to treat several conditions including rheumatoid arthritis, systemic lupus erythematosus, some skin conditions especially photosensitive ones and others that involve inflammation. The usual dose is 400 mg daily in one or two divided doses. Common side effects include headaches, dizziness, gastrointestinal upset and rash. Retinopathy is a serious side effect of hydroxychloroquine and regular ophthalmologic monitoring is recommended for patients on long term therapy.