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. Toxic dose of chloroquine Plaquenil for lupus weight loss Plaquenil liver Doses ≥ 5 mg/kg/day real weight of hydroxychloroquine 2.3 mg/kg/day of chloroquine are associated with higher risk of toxicity. Doses lower than 5 mg/kg/day have low risk 1% for the first 5 years, and below 2% between 5-10 years of use. Retinal toxicity from hydroxychloroquine is rare, but even if the medication is discontinued, vision loss may be irreversible and may continue to progress. It is imperative that patients and physicians are aware of and watch for this drug’s ocular side effects. 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. Related More than a yellow lesion? Is there really a scarcity in cases, though? New information shows that hydroxychloroquine retinal toxicity occurs 7.5 percent of the time, which is not that rare. 3 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. Retinal toxicity dosage hydroxychloroquine New Guidelines on Hydroxychloroquine Dosage - Where Are We., Hydroxychloroquine-Induced Retinal Toxicity - American. Tests to get before starting hydroxychloroquine Factors that increase the risk of developing hydroxychloroquine associated retinal toxicity include daily dose, cumulative dose, renal or liver impairment, older age, and prior retinal disease. Specifically, a daily dose of 6.5mg/kg based on ideal body weight and a cumulative dose of 1000g of hydroxychloroquine or 460g of chloroquine are both considered risk factors for retinal toxicity. Retinal Screening for Hydroxychloroquine Plaquenil Toxicity Retina.. Determine risk for hydroxychloroquine retinal toxicity Optometry Times. Despite Plaquenil dosing recommendations, retinal toxicity.. The risk of a toxicity sharply increases after 5 years, with majority of cases of retinotoxicity occurring 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 retinopathy is most influenced by daily dose and duration of use. Risk for toxicity is less with 5.0 mg/kg real weight/day for hydroxychloroquine and 2.3 mg/kg real weight/day for chloroquine. Patients are at low risk during the first 5 years of treatment. Dosage. The 2002 recommendations considered a daily dose at or below 6.5 mg/kg/day of hydroxychloroquine to be low-risk for subsequent toxicity. Hydroxychloroquine is dispensed in 200 mg tablets, so an “average” 70-kg patient using the common dose of 200 mg bid actually would be receiving a slight overdose according to this threshold.