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 hypercalcemia Is plaquenil discontinued Risk of Toxicity. DOSAGE IS SUPPOSED TO BE BASED ON IDEAL WEIGHT WOMEN 100 LBS FOR 5 FT AND 5 LBS FOR EACH EXTRA INCH OF HEIGHT – 5 ‘ 2 ‘’ SHOULD BE 110 LBS. MEN ADD 10 LBS - 5 ‘ 8 ‘’ SHOULD BE 150 LBS. 6.5 MG/KG/DAY. CUMULATIVE DOSE IS THE TRIGGER FOR TOXICITY 1000 GRAMS THE TIPPING POINT. Abstract. Background The American Academy of Ophthalmology recommendations on screening for chloroquine CQ and hydroxychloroquine HCQ retinopathy are revised in light of new information about the prevalence of toxicity, risk factors, fundus distribution, and effectiveness of screening tools. Pattern of Retinopathy Although the locus of toxic damage is parafoveal in many eyes, Asian. The new guidelines recommend 10-2 automated perimetry, plus at least one of SD-OCT, FAF, or mfERG if they are available. These tests should be performed at baseline and at each subsequent evaluation. Other tests may be considered as well, but are generally insufficiently sensitive to detect early evidence of hydroxychloroquine toxicity. 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 guidelines for eye monitoring 2016 Plaquenil - Eye Doctor MD, Recommendations on Screening for Chloroquine and. Hydroxychloroquine fetal hemoglobin The goal of monitoring/screening is to identify early macular damage prior to irreversible vision loss or even before visible signs of bull’s eye maculopathy. And although the current guidelines do not discuss the importance of continuous ocular care with an annual comprehensive eye exam, we believe that it is an essential consideration. 1. New Plaquenil Guidelines -. Retinal Physician - New Screening Guidelines for.. New Guidelines for Hydroxychloroquine Visual Screening. 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. That recommendation was lowered in March 2016 to 5.0 mg per kg of actual body weight, up to a maximum of 400 mg a day. As a treatment for sarcoidosis, the antimalarial drug hydroxychloroquine Plaquenil® is most likely to be effective in patients with dermatologic involve-ment, joint manifestations and hypercalcemia. Due to poten-tial macular toxicity, it is recommended that patients on hydroxychloroquine have an eye examination every 6-12 months. Methotrexate.