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 and sun exposure How does plaquenil affect the retina Plaquenil manufacturer meloxicam Let's dive in. Melton & Thomas describe the typical safe Plaquenil dosage this way The usual dosage is two 200mg tablets per day. This is generally a "safe" dose for patients having a lean body weight of at least 135 lbs. The generally-regarded safe dosage is 6.5mg/kg/qd, thus the 135 lb. safety threshold. Mar 15, 2019 If the maximum daily dosage recommendations are followed, the likelihood of toxicity from chloroquine or hydroxychloroquine is less than 1% the first five years of treatment. Corneal epithelial changes are usually reversible, but retinopathy caused by these agents are not. Feb 19, 2020 The action of hydroxychloroquine is cumulative and may require weeks to months to achieve the maximum therapeutic effect see CLINICAL PHARMACOLOGY. Initial adult dosage 400 mg to 600 mg 310 to 465 mg base daily, administered as a single daily dose or in two divided doses. 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 cumulative dose toxicity Plaquenil-Induced Toxic Maculopathy - Decision-Maker PLUS, Chloroquine and Hydroxychloroquine Toxicity Practice. Side effects of plaquenil and methotrexatePlaquenil toxicity fundus autofluorescence A cumulative dose of 1000g of hydroxychloroquine or 460g of chloroquine was likely the largest risk factor, which was typically achieved after 5-7 years of a typical dosage 8, 10. However, there have been case reports of patients with hydroxychloroquine toxicity as early as 1.9 months after starting treatment 11. Hydroxychloroquine Plaquenil Toxicity and Recommendations.. Plaquenil Hydroxychloroquine Uses, Dosage, Side Effects.. Chloroquine And Hydroxychloroquine Toxicity - StatPearls.. Risk factors for toxicity. Reported risk factors for toxicity include daily dose 400 mg, or 6.5 mg/kg ideal/lean body weight for short individuals; cumulative dose 1000 g; duration of use 5 years; renal or hepatic dysfunction; obesity; age 60 years; and pre-existing retinal disease or maculopathy 31. Apr 20, 2011 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. 2,3. The associated classic retinal toxicity is described as a bull’s eye maculopathy ring of depigmented retinal pigment epithelium that spares the foveal area. 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.