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. Hydroxychloroquine sulfate adverse reactions Chloroquine autophage 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. 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. 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. 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 Chloroquine Professional Patient Advice -, SARCOIDOSIS TREATMENT GUIDELINES Patent for proguanil chloroquine malariaChloroquine phosphate vetStopping plaquenil side effectsHydroxychloroquine for crest syndromeReddit plaquenil weight loss Previous 30 recommendations by the AAO to limit HCQ dosing to 6.5 mg/kg of ideal body weight have been 31 revised to 5 mg/kg of actual body weight 5. Some authors recommend 6.5 mg/kg of actual 32 body weight with a cap at 400 mg per day and further adjustments for renal insufficiency 10. AMERICAN COLLEGE OF RHEUMATOLOGY. Recommendations on Screening for Chloroquine and.. New Guidelines on Hydroxychloroquine Dosage - Where Are We.. There was a dose response, such that those receiving doses greater that 5 mg / kg had the greatest risk of retinal toxicity. Risk factors for retinopathy included higher doses and longer durations of use. Other major factors are concomitant renal disease, use of tamoxifen and prior retinal or macular disease. The American Academy of Ophthalmology’s recommendations for screening of chloroquine CQ and hydroxychloroquine HCQ retinopathy were published in 2002. The new guidelines also recommend that in addition to 10-2 automated fields, at least one of the newer objective tests be used, such as multifocal electroretinogram, spectral domain. To reduce the incidence of chloroquine and hydroxychloroquine toxicity, health care providers HCP's that prescribe these medications and those that screen for ocular toxicity have developed clear dosing and screening protocols that have reduced the risk of end-stage disease; bull's eye maculopathy and central vision loss Level I.