Pattern of Retinopathy: Although the locus of toxic damage is parafoveal in many eyes, Asian patients often show an extramacular pattern of damage. Dose: We recommend a maximum daily HCQ use of 5.0 mg/kg real weight, which correlates better with risk than ideal weight. Dmard therapy hydroxychloroquine Plaquenil side effects skin discoloration Plaquenil and epidural anesthesia How does azathioprine work with plaquenil for lupus The American Academy of Ophthalmology released an updated set of screening recommendations for hydroxychloroquine Plaquenil and chloroquine to account for the many studies that have shown the effects of these medications on the retina 1. It succinctly makes the case for screening, and CASE REPORT A 61-year-old woman with rheumatoid arthritis treated with 400 mg/kg hydroxychloroquine daily for 6 years daily dose, 5.72 mg/real body weight or 6.5 mg/kg ideal body weight; cumulative dose, 876 g experienced progressive central vision loss and a scotoma affecting her reading ability and was referred to the Retina service. Prior yearly examination with only Ishihara color vision and Amsler grid testing was normal. Maintenance dose 200 to 400 mg 155 to 310 mg base orally daily Comments-Each dose should be taken with a meal or a glass of milk.-Retinopathy has been reported to be higher when the maintenance dose is exceeded. Risk of Toxicity: The risk of toxicity is dependent on daily dose and duration of use. There are no similar demographic data for CQ, but dose comparisons in older literature suggest using 2.3 mg/kg real weight. Hydroxychloroquine retinopathy cumulative dose Hydroxychloroquine-Induced Retinal Toxicity - American., Case Report Hydroxychloroquine Retinopathy Optometry and. Plaquenil drug rashPlaquenil discoid lupusHydroxychloroquine corneal verticillata An appropriate dose is required to minimize the risk of hydroxychloroquine related retinopathy and to permit long-term use in most patients. The overall risk of developing hydroxychloroquine retinopathy in patients on long-term therapy is 7.5% with the risk increasing with higher doses and long-term use. Hydroxychloroquine Plaquenil Dosing Calculator - MDCalc. Hydroxychloroquine Dosage Guide with Precautions -. Hydroxychloroquine retinopathy Eye. Pattern of Retinopathy Although the locus of toxic damage is parafoveal in many eyes, Asian patients often show an extramacular pattern of damage. Dose We recommend a maximum daily HCQ use of 5.0 mg/kg real weight, which correlates better with risk than ideal weight. There is an increased risk of HCQ retinopathy with increase in the cumulative dose. Per the prior 2011 AAO guidelines the recommended maximum dose to minimize HCQ retinal toxicity was 6.5 mg /kg based on ideal body weight 2. The advantage of the real body weight formula is that it distributes the risk evenly on a broad range of body habitus. Hydroxychloroquine retinopathy is most influenced by daily dose, length of use, and cumulative dose over time. Risk for toxicity is least with less than 6.5 mg/kg/day for hydroxychloroquine and 3 mg/kg/day for chloroquine.