She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Sketchypharm hydroxychloroquine Symptoms of plaquenil allergy Recent studies estimate that about 1% of patients develop toxic maculopathy after 5 years of treatment with plaquenil or chloroquine. The risk of maculopathy is associated with cumulative dose level of 1,000 grams and it usually takes 5-7 years for patients on the standard treatment of 250-400 milligrams per day to reach that level. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy Retinal toxicity from chloroquine CQ and its analogue, hydroxychloroquine HCQ, has been recognized for many years. Chloroquine toxicity remains a problem in many parts of the world, but is seen less frequently in the United States where the drug largely has been. Cumulative dose 1000 g total HCQ 460 g total CQ Daily Dose Hydroxychloroquine HCQ Chloroquine CQ 400 mg/day 6.5 mg/kg ideal body weight for short individuals 250 mg/day 3.0 mg/kg ideal body weight for short individuals Age Elderly Systemic disease Kidney or liver dysfunction Ocular disease Retinal disease or maculopathy Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Chloroquine maculopathy cumulative dose Revised Recommendations on Screening for Chloroquine and., Recommendations on Screening for Chloroquine and. Visual field for plaquenilWhat happens if i stop taking plaquenil Usual Adult Dose for Malaria Prophylaxis. Suppression 400 mg 310 mg base orally on the same day every week Comments-Suppressive therapy should begin 2 weeks prior to exposure; however, failing this, an initial dose of 800 mg 620 mg base may be taken in 2 divided doses 6 hours apart. Hydroxychloroquine Dosage Guide with Precautions -. Early Plaquenil Toxicity Detected without Bull’s Eye.. Retinal Physician - Hydroxychloroquine Maculopathy An.. Dose equivalence and conversion. Doses expressed as chloroquine base. Each tablet contains 155 mg of chloroquine base equivalent to 250 mg of chloroquine phosphate. Syrup contains 50 mg/5 mL of chloroquine base equivalent to 80 mg/5 mL of chloroquine phosphate. Current recommendation for minimal effective doses – 300mg/day or less with an absolute maximum of 800mg/day for very short period of time. Toxicity is more dependent on total daily dose than on cumulative dose If the drug is stopped early after the onset of symptoms, the patients usually report improvement in vision. The recommended adult dosage is 200 to 400 mg 155 to 310 mg base daily, administered as a single daily dose or in two divided doses. Doses above 400 mg a day are not recommended. The incidence of retinopathy has been reported to be higher when this maintenance dose is exceeded.