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. Methylene blue falciparum chloroquine reversal Chloroquine gene transfection Plaquenil sunburn In 2011, guidelines warned about toxicity risk at a cumulative dose of 1000 g or exceeding 6.5 mg/kg body weight/day. For a typical patient, most would reach the cumulative dose at 200 mg bid in 5 years. 2 It is rare for vision changes to occur. Studies have shown that patients who have manifested with retinopathy have traces of Plaquenil metabolites in their erythrocytes, plasma, and urine even after 5 years of discontinuing the medication 1, 2, 3. Risk Factors. There are risk factors which may increase the likelihood of an individual in developing symptoms of Plaquenil toxicity 1. Plaquenil-induced maculopathy is a form of retinal toxicity that is associated with long-term use of of the anti-inflammatory medication plaquenil. The drug-induced maculopathy is associated with the following risk factors Cumulative dose level of 1,000 grams of plaquenil. Patients with existing retinal or macular disease. 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. Plaquenil maculopathy risk Drug induced maculopathy - EyeWiki, Plaquenil Toxicity - Symptoms, Treatment, Risk Factors. Plaquenil for lupus review alkaline inflammation Risk factors that increase the chance of hydroxychloroquine retinopathy include daily dosage, cumulative dose, renal or liver disease, age, and previous retinal disease 9. A daily dose of 6.5mg/kg ideal body weight places patients at higher risk, but a daily dose below this level did not preclude the patient from developing toxicity after many years of treatment. Hydroxychloroquine Plaquenil Toxicity and Recommendations.. Plaquenil-Induced Toxic Maculopathy - Decision-Maker PLUS. Hydroxychloroquine toxicity - EyeWiki. Feb 19, 2020 SIDE EFFECTS. The following adverse reactions have been identified during post-approval use of PLAQUENIL or other 4-aminoqunoline compounds. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Another study of 4000 patients found a prevalence of 6.8/1000 patients 8. Risk factors that increase the chance of hydroxychloroquine retinopathy include daily dosage, cumulative dose, renal or liver disease, age, and previous retinal disease 9. The AAO guidelines defined high-risk patients by any one of the following criteria HCQ treatment 5 years in duration, HCQ dose 6.5 mg/kg/day, significant renal or hepatic disease, preexisting maculopathy due to other etiology, age 60 years, obesity, or cumulative HCQ consumption of 1000 g.