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 and daypro used together Plaquenil use for sjogrens syndrome Drug interactions with hydroxychloroquine Rheumatoid Arthritis. 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. In a small percentage of patients, side effects may require temporary reduction of the initial. Recommendations released in 2016 by the American Academy of Ophthalmology for hydroxychloroquine emphasize the risk for retinopathy and suggest the dose be limited to 5 mg/kg of body weight. AAO Screening Guidelines for Plaquenil by S P Check out my recent review/summary of the American Academy of Ophthalmology’s statement on the Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy 2016 Revision from the Ophthalmology Journal 2016;186-1394. 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). Aao plaquenil 2016 guidelines Clinical guidelines - American Academy of Dermatology, Experts debate hydroxychloroquine dosing guidelines in lupus Chloroquine dose in malariaMalaria hydroxychloroquine resistanceHydroxychloroquine cream side effects 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 Hydroxychloroquine And Chloroquine Screening 2016 AAO.. AAO Screening Guidelines for Plaquenil. Despite Plaquenil dosing recommendations, retinal toxicity.. Marmor MF, Kellner U, Lai TY, Melles RB, Mieler WF, American Academy of O. 94 Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy 2016 95 Revision. Ophthalmology. 2016. 96 6. Levy GD, Munz SJ, Paschal J, Cohen HB, Pince KJ, Peterson T. Incidence of Hydroxychloroquine is a well-tolerated medication for various rheumatologic and dermatologic conditions. Its main side effects are gastrointestinal upset, skin rash, headache, and ocular toxicity1. Within the eye, hydroxychloroquine can adversely impact the cornea, ciliary body, and retina1 Apr 20, 2011 In 2002, the American Academy of Ophthalmology AAO established ocular examination guidelines for screening patients on Plaquenil therapy. Testing included a comprehensive eye exam that consisted of an assessment of the posterior segment with careful evaluation of associated macular changes or signs of retinal disease. 4 Baseline fundus.