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. When was chloroquine discovered Hydroxychloroquine and aspirin The most critical risk factor for the development of HCQ toxicity is excessive daily dose by weight. 2 Dosage 5.0 mg/kg dramatically increases both population risk and annual incremental risk, and extreme doses can be exceedingly dangerous. 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. The prevalence of retinal toxicity was 36.2% among patients who used ≤200 mg HCQ per day and 8.3% among those who used 200 mg HCQ per day, and there was no significant association between daily HCQ dose and retinal toxicity P = 0.062. 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 Despite Plaquenil dosing recommendations, retinal toxicity., Plaquenil Risk Calculators Does plaquenil make you immunosuppressedPlaquenil oct findingsPlaquenil sleepCan plaquenil change anaChloroquine elimination half life 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. Hydroxychloroquine-related retinal toxicity Rheumatology.. Retinal Toxicity in Patients Treated With Hydroxychloroquine.. Hydroxychloroquine Dosage Guide with Precautions -. Hydroxychloroquine sulfate HCQ, Plaquenil is an analogue of chloroquine CQ, an antimalarial agent, used for the treatment of systemic lupus erythematosus, rheumatoid arthritis and other autoimmune disorders. Its use has been associated with severe retinal toxicity, requiring a discontinuation of therapy. Following a single 200 mg oral dose of PLAQUENIL to healthy male volunteers, the mean peak blood concentration of hydroxychloroquine was 129.6 ng/mL, reached in 3.26 hours with a half-life of 537 hours 22.4 days. In 2011, guidelines warned about toxicity risk at a cumulative dose of 1000 g or exceeding 6.5 mg/kg body weight/day. For a typical patient, most would reach the cumulative dose at 200 mg bid in 5 years. 2 It is rare for vision changes to occur.