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 pictures generic Hydroxychloroquine plus baflomycin lysosome inhibitor However in 2016, the price dramatically increased from ~ $0.16 to $6 per pill. Cost of biologic is ~$4000 for 40mg Humira for a 2 week dose Retinal toxicity is fairly rare. how rare is a big question Rheumatologists LOVE Plaquenil. SO MUCH LOVE. The most common side effects are nausea and diarrhea, which One PLAQUENIL tablet contains 200 mg of hydroxychloroquine sulfate, which is equivalent to 155 mg base. Take PLAQUENIL with a meal or a glass of milk. The most recent 2016 guidelines from the American Academy of Ophthalmology AAO recommend the dose of HCQ ≤5 mg/kg real body weight to minimize toxicity 1. According to these new guidelines, the risk of HCQ retinal toxicity is less than 1 % in the first year of therapy and less than 2 % up to 10 years of therapy. 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). Plaquenil guidelines for eye monitoring 2016 Retinal Physician - New Screening Guidelines for., Plaquenil Dosage Guide - Chloroquine phosphate fish treatment Screening guidelines were updated this year, with some pertinent changes for our profession to note. Cumulative dose is no longer a risk factor, but more of a tool in the screening of our patients. New Guidelines for Hydroxychloroquine Visual Screening. New Guidelines on Hydroxychloroquine Dosage - Where Are We.. AMERICAN COLLEGE OF RHEUMATOLOGY. Periodic monitoring for early signs of macular toxicity, to lessen the risk of visual loss. Symptoms Over time, Plaquenil can accumulate in the retina and cause permanent irreversible damage to the center of vision. The classic retinal changes appear as a “bull’s eye” area of discoloration of the central part of the retina. Risk of Toxicity. DOSAGE IS SUPPOSED TO BE BASED ON IDEAL WEIGHT WOMEN 100 LBS FOR 5 FT AND 5 LBS FOR EACH EXTRA INCH OF HEIGHT – 5 ‘ 2 ‘’ SHOULD BE 110 LBS. MEN ADD 10 LBS - 5 ‘ 8 ‘’ SHOULD BE 150 LBS. 6.5 MG/KG/DAY. CUMULATIVE DOSE IS THE TRIGGER FOR TOXICITY 1000 GRAMS THE TIPPING POINT. That recommendation was lowered in March 2016 to 5.0 mg per kg of actual body weight, up to a maximum of 400 mg a day.