Most importantly, you help support continued development of this site. The majority of cases of retinotoxicity have occurred 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). Hydroxychloroquine binding action of mechanism Hydroxychloroquine for vasculities rash Safe to take plaquenil with antacids Chloroquine cholera On examination, a telltale sign of hydroxychloroquine toxicity is a bilateral change in the retinal pigment epithelium of the macula that gives the commonly described appearance of a bull’s-eye. This is a late finding, however, and too late for screening to be useful. 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. A baseline ocular examination is recommended within the first year of starting PLAQUENIL. The baseline exam should include best corrected distance visual acuity BCVA, an automated threshold visual field VF of the central 10 degrees with retesting if an abnormality is noted, and spectral domain ocular coherence tomography SD-OCT. It now solely uses real body weight (rather than ideal body weight) based on new recommendations from a 2014 study (1). Disclaimer: This tool is designed to help eye care professionals better understand the risk the of retinotoxicity from hydroxychloroquine. Please note: This calculator was modified in 9/2015. Hydroxychloroquine eye exam frequency HYDROXYCHLOROQUINE SULFATE Drug BNF content published by NICE, Recommendations on Screening for Chloroquine and. Hydroxychloroquine gingival hyperplasiaChloroquine and proguanil doseMore energy on plaquenilChloroquine phosphate lethal Conclusions We identified HCQ in toxicity 1.7 % and bull's eye lesions in 0.7%.92.3% of patients are in high or very high-risk categories. Risk categories appeared to be weakly related to observed toxicity. There was no relation between risk categories and screening examination frequency. Hydroxychloroquine HCQ Eye Examination Frequency.. Plaquenil Hydroxychloroquine Uses, Dosage, Side Effects.. How to Succeed in Plaquenil Screenings. 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. Dosage for Plaquenil. The adult dose of Plaquenil to suppress malaria is 400 mg on the same day each week. The pediatric weekly suppressive dosage is 5 mg/kg of body weight. The adult dose of Plaquenil to treat an acute attack of malaria is an initial dose of 800 mg followed by 400 mg in six to eight hours and 400 mg for two more days. Irreversible retinal damage observed in some patients who had received hydroxychloroquine sulfate; significant risk factors for retinal damage include daily doses of hydroxychloroquine sulfate greater than 6.5 mg/kg 5 mg/kg base of actual body weight, durations of use greater than five years, subnormal glomerular filtration.