Plaquenil retinal screening guidelines

Discussion in 'Trust Pharmacy Canada' started by heshik, 09-Mar-2020.

  1. White_ud Guest

    Plaquenil retinal screening guidelines


    One such commonly used medication for dermatologic and rheumatologic inflammatory conditions is hydroxychloroquine (Plaquenil), a chloroquine derivative. It is used to treat many diseases including malaria, rheumatoid arthritis and systemic lupus erythematosus.

    Hydroxychloroquine sulfate contraindications Plaquenil drug uses

    Patients taking Plaquenil should have an early baseline assessment of visual acuity, macular appearance and central field sensitivity. The macular appearance and function should be checked at intervals of 6 to 12 months. AAO revised guidelines. The AAO published dosing and screening recommendations for chloroquine and hydroxychloroquine in 2016, revising previous recommendations published in 2011. The current maximum daily HCQ dose recommended by the AAO is 5 mg/kg of real weight. The 2011 guidelines suggested a maximum dose of 6.5 mg/kg of ideal weight. Nov 01, 2015 Hydroxychloroquine Maculopathy An Update on Screening and Diagnosis A brief guide for imaging SHIRI SHULMAN, MD. H ydroxychloroquine HCQ; Plaquenil, Sanofi, Bridgewater, NJ is an antimalarial agent that is also commonly used as a treatment for a variety of rheumatologic and dermatologic conditions, such as rheumatoid arthritis and systemic lupus erythematosus.

    It is imperative that patients and physicians are aware of and watch for this drug’s ocular side effects. Retinal toxicity from hydroxychloroquine is rare, but even if the medication is discontinued, vision loss may be irreversible and may continue to progress.

    Plaquenil retinal screening guidelines

    Hydroxychloroquine Retinopathy Still Alive and Well - The., Despite Plaquenil dosing recommendations, retinal toxicity.

  2. Chloroquine resistance areas
  3. Is hydroxychloroquine a quinine
  4. Kidney and liver disease predispose to hydroxychloroquine toxicity due to impaired clearance of the drug. Old age is hypothesized to contribute to overall risk due to the natural aging process of the retinal pigment epithelium RPE, causing the RPE to be more sensitive to toxic drugs.

    • Hydroxychloroquine toxicity - EyeWiki.
    • Retinal Physician - Hydroxychloroquine Maculopathy An Update..
    • Hydroxychloroquine retinopathy Eye.

    Currently, one of the primary functional screening tests recommended for the evaluation of Plaquenil retinal toxicity is 10-2 white stimulus automated visual fields; however, research shows Asian patients benefited from 24-2 or 30-2 visual fields, given that toxicity often manifests changes beyond the macula in these patients. 9 Because spectral-domain optical coherence tomography SD-OCT is readily accessible and able to detect early structural damage prior to clinical funduscopic findings. The scope of the guidelines is limited to management of diabetic retinopathy with special focus on sight threatening retinopathy. It offers guidance regarding service set up to facilitate delivery of optimal clinical care for patients with retinopathy. The guidelines are prepared primarily for ophthalmologists. In 2002, the American Academy of Ophthalmology AAO established ocular examination guidelines for screening patients on Plaquenil therapy. Testing included a comprehensive eye exam that consisted of an assessment of the posterior segment with careful evaluation of associated macular changes or signs of retinal disease. 4 Baseline fundus photography was considered as an optional test.

     
  5. mavr Guest

    Dosing schedules not well established in children Case reports describe dosage regimens that are effective yet tolerated, such as 12.5 mg PO twice weekly over 2 yr in a child aged 4-6 yr, and 100 mg PO twice weekly over 5 months in a child aged 12 yr; mg/kg dosing not reported Hypersensitivity to chloroquine, 4-aminoquinolones Psoriasis, porphyria, retinal or visual field changes For prevention, may use proguanil concomitantly Shown to cause severe hypoglycemia including loss of consciousness that could be life-threatening in patients treated with or without antidiabetic medications; patients should be warned about risk of hypoglycemia and associated clinical signs and symptoms; patients presenting with clinical symptoms suggestive of hypoglycemia during treatment with chloroquine should have blood glucose level checked and treatment reviewed as necessary Not effective in most areas; CDC recommends mefloquine or atovaquone/proguanil - check CDC traveler information for specific recommendations for region May cause hemolysis in glucose-6 phosphate dehydrogenase (G-6-PD) deficiency; blood monitoring may be needed as hemolytic anemia may occur, in particular in association with other drugs that cause hemolysis Monitor CBC periodically with prolonged therapy Caution with history of auditory damage Caution with hepatic disease, alcoholism, and coadministration with other hepatotoxic drugs May provoke seizures in patients with history of epilepsy Antacids and kaolin reduce chloroquine absorption; separate administration by at least 4 hr Irreversible retinal damage observed in some patients; significant risk factors for retinal damage include daily doses of chloroquine phosphate 2.3 mg/kg of actual body weight, durations of use greater than five years, subnormal glomerular filtration, use of some concomitant drug products such as tamoxifen citrate, and concurrent macular disease A baseline ophthalmological examination should be performed within the first year of initiating therapy; for individuals with significant risk factors, monitoring should include annual examinations; discontinue if ocular toxicity is suspected; patient should be closely observed given that retinal changes (and visual disturbances) may progress even after cessation of therapy In individuals of Asian descent, retinal toxicity may first be noticed outside macula; it is recommended that visual field testing be performed in visual field of central 24 degrees instead of central 10 degrees May exacerbate heart failure Not effective against chloroquine- or hydroxychloroquine-resistant strains of Plasmodium species; information regarding geographic areas where resistance to chloroquine occurs, is available at the Centers for Disease Control and Prevention (gov/malaria) Does not treat hypnozoite liver stage forms of Plasmodium and will therefore not prevent relapses of malaria due to P. ovale; additional treatment with an anti-malarial agent active against these forms, such as an 8-aminoquinoline, is required for the treatment of infections with P. ovale Cases of cardiomyopathy resulting in cardiac failure, in some cases with fatal outcome, reported during long term therapy at high doses; monitor for signs and symptoms of cardiomyopathy and discontinue chloroquine if cardiomyopathy develops; chronic toxicity should be considered when conduction disorders (bundle branch block / atrio-ventricular heart block) diagnosed; if cardiotoxicity suspected, prompt therapy discontinuation may prevent life-threatening complications QT interval prolongation, torsades de pointes, and ventricular arrhythmias reported; risk is greater if chloroquine is administered at high doses; fatal cases reported; use with caution in patients with cardiac disease, a history of ventricular arrhythmias, uncorrected hypokalemia and/or hypomagnesemia, or bradycardia ( There are no adequate and well-controlled studies evaluating the safety and efficacy of chloroquine in pregnant women; usage during pregnancy should be avoided except in prophylaxis or treatment of malaria when benefit outweighs potential risk to fetus Because of the potential for serious adverse reactions in nursing infants from chloroquine, a decision should be made whether to discontinue nursing or to discontinue drug, taking into account potential clinical benefit of drug to mother A: Generally acceptable. Individual plans may vary and formulary information changes. Aralen chloroquine Malaria Drug Side Effects & Dosage Chloroquine Phosphate chloroquine phosphate dose. Chloroquine C18H26ClN3 - PubChem
     
  6. spirtus User

    Recent publications have brought attention to the possible benefit of chloroquine, a broadly used antimalarial drug, in the treatment of patients infected by the novel emerged coronavirus (SARS-Co V-2). Chloroquine Indications, Side Effects, Warnings - Chloroquine phosphate? Chloroquine phosphate Louisiana Reef Club
     
  7. LightEnergy XenForo Moderator

    Chloroquine - FDA prescribing information, side effects and uses Oct 01, 2018 Mechanism of Action Chloroquine, a 4-aminoquinoline, is an anti-protozoal agent. The precise mechanism by which Chloroquine exhibits activity is not known. Chloroquine, may exert its effect against Plasmodium species by concentrating in the acid vesicles of the parasite and by inhibiting polymerization of heme. It can also inhibit certain.

    Flonase Side Effects Common, Severe, Long Term -