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. Chloroquine ic50 What is plaquenil for lupus Depending on the patient's condition, the dosage can be tapered at those visits. After 3-6 months, the dose should be tapered to physiolog- ic levels – for example, 10 mg of prednisone per day or less. corticosteroids, one should consider the addition of a steroid-sparing agent, such as methotrexate or azathioprine. The maximum safe dose is 5 mg/kg of actual body weight. For example, a patient who weighs 175 lb would be at a threshold dose when taking 400 mg daily. Screening interval has also been updated. All patients will need a baseline screening before or within 1 year of initiation of hydroxychloroquine. Jan 05, 2020 Risk for toxicity is least with less than 6.5 mg/kg/day for hydroxychloroquine and 3 mg/kg/day for chloroquine. Patients are at low risk during the first 5 years of treatment. Cumulative use in excess of 250 grams increases the risk for toxic retinopathy. Other risk factors include obesity, kidney or liver disease, older age. 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). Chloroquine dosage ophthalmology guidelines AMERICAN COLLEGE OF RHEUMATOLOGY, New Guidelines for Hydroxychloroquine Visual Screening Plaquenil freshnessPlaquenil toxicity autofluorescencePlaquenil lupus remissionPlaquenil manufacturer Usual Adult Dose for Malaria Prophylaxis. Suppression 400 mg 310 mg base orally on the same day every week Comments-Suppressive therapy should begin 2 weeks prior to exposure; however, failing this, an initial dose of 800 mg 620 mg base may be taken in 2 divided doses 6 hours apart. Hydroxychloroquine Dosage Guide with Precautions -. Hydroxychloroquine toxicity - EyeWiki. Despite Plaquenil dosing recommendations, retinal toxicity.. The latest guidelines from the American Academy of Ophthalmology, the Royal College of Ophthalmology and EULAR 2, 134, 141 recommend the use of a lower dose of hydroxychloroquine maximum of. At the recommended dose, development of visual problems due to the medication is rare. It is recommended that you have an eye exam within the first year of use, then repeat every one to five years based on current guidelines. Occurs. They should take one dose per week while there, and for 4 consecutive weeks after leaving. The weekly dosage for adults is 300mg base 500mg salt. Your doctor will have calculated the correct weekly. dose for your child based on the child’s weight. The child’s dose should not exceed the adult dose of 300mg base 500mg salt per week.