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. Dr gave me plaquenil to sample Finasteride vs plaquenil Plaquenil brand What is hydroxychloroquin Presentation. The risk of toxicity is low for individuals without complicating conditions during the first 5 years of treatment using less than 6.5 mg/kg/day of hydroxychloroquine or 3 mg/kg/day of chloroquine, and/or cumulative doses of less than 1000 gram and 460 gram total dose, respectively. A cumulative dose of 1000g HCQ is reached in 7 years with a typical daily dose of 400 mg. In the same study, toxicity was not related to age, weight or daily dose but was related to duration of use and increased rapidly after 5 to 7 years; thus, it is important to be aware of the risk factors and use more effective protocols of screening on all the patients who exceed 5 years of exposure. 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. 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 Determine risk for hydroxychloroquine retinal toxicity., Retinal toxicity associated with chronic exposure to hydroxychloroquine. Chloroquine-medicated saltOct of macular damage secondary to plaquenil toxicityHow to treat plaquenil rash Last February I discontinued taking plaquenil after 22 years of being on 400mg a day 200mg 2x day. When I had my annual eye exam the dr told me I had reached the max plaquenil toxicity level which could cause retina cell to die. The good news is that the eye exam did not have any evidence of this problem. Plaquenil Toxicity" Lupus Community - Support Group. New Plaquenil Guidelines. Plaquenil Dosage Guide -. The risk of a toxicity sharply increases after 5 years, with majority of cases of retinotoxicity occurring 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. 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. The same study revealed that the most important predictor of toxicity was the duration of use cumulative dose and that age, the daily dose, and patient weight did not correlate significantly with HCQ toxicity. One reaches a cumulative dose of 1000 grams 1 kilogram at 7 years when taking the most commonly prescribed dose of 400 mg a day.