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. Plaquenil anger Does hydroxychloroquine cause vision loss Can plaquenil help skin cancer 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. Most cases of chloroquine retinopathy have developed when a higher than currently recommended 3 mg/kg/day using lean body weight dose was used. 21 A daily dose exceeding 250 mg with a total cumulative dose between 100 and 300 g is customarily needed to produce toxicity. 22 One study showed a 19% incidence of chloroquine retinopathy in patients taking a mean daily dose of 329 mg. 23 On the other hand, with strict adherence to a low dose per day, the incidence of retinal abnormalities is. The cumulative dose of Chloroquine was previously considered to be of significance as a risk factor for development of maculopathy. This was contradicted by recent studies that suggested that the daily intake adjusted to lean ideal body weight actual body weight—body fat is a more important risk factor 14, 25, 26. 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 Recommendations on Screening for Chloroquine and., Chloroquine Retinopathy - an overview ScienceDirect Topics Can i take tramadol with plaquenilPlaquenil therapy for sjogrens icd 10 A cumulative dose of 1000g of hydroxychloroquine or 460g of chloroquine was likely the largest risk factor, which was typically achieved after 5-7 years of a typical dosage 8, 10. However, there have been case reports of patients with hydroxychloroquine toxicity as early as 1.9 months after starting treatment 11. Hydroxychloroquine Plaquenil Toxicity and.. Spectral-Domain Optical Coherence Tomography of Preclinical.. Retinal toxicity associated with chronic exposure to.. 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 Chloroquine and hydroxychloroquine belong to the quinolone family. They are related drugs with similar clinical indications for use and similar manifestations of retinal toxicity, although their therapeutic and toxic doses differ. A woman aged 28 years with systemic lupus erythematous and abnormal kidney function, treated with 45 mg/kg hydroxychloroquine daily for 15 years cumulative dose 1369 g, presented with bilateral progressive central vision loss for 2 months. The patient had no known previous exposure to chloroquine. Best corrected visual acuity was 20/40 in her right eye and 20/30 in her left eye. Funduscopy.