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 200 mg tablet sanofi Homocysteine plaquenil The risk increases with a higher dose and longer therapy. Vision risks. Hydroxychloroquine is dosed according to body weight. The American Academy of Ophthalmology AAO currently defines an overdose of hydroxychloroquine as more than 5.0 milligrams mg per kilogram kg of body weight 1 kg equals 2.2 pounds or more than 400 mg a day. Patients were prescribed hydroxychloroquine not to exceed 6.5mg/kg max400mg/day. In hemodialysis, the dose was 200mg after each session, in renal insufficiency it was 200mg/day. Levels were measured at each visit with a therapeutic range of 500-2000 ng/ml. Patients were divided according to baseline blood level. Common, nonocular, side effects of chloroquine and hydroxychloroquine include pruritus, headaches, dizziness, and gastrointestinal upset. Less frequent side effects include discoloration of the oral cavity, nails, skin and hair and rash. HCQ myopathy is uncommon and presents with proximal muscle weakness and rarely ventilatory failure. 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). At risk lifetime dosage of hydroxychloroquine Chronic hydroxychloroquine/chloroquine exposure for., Hydroxychloroquine Blood Levels in SLE Clarifying dosing. Lysosomal acidification chloroquine INTRODUCTION Hydroxychloroquine HCQ is an alkalinizing lysosomatropic drug that accumulates in lysosomes where it inhibits some important functions by increasing the pH. HCQ has proved to be effective in a number of autoimmune diseases including systemic lupus erythematosus SLE. Hydroxychloroquine in systemic lupus erythematosus SLE.. Chloroquine And Hydroxychloroquine Toxicity - StatPearls.. Hydroxychloroquine Plaquenil Side Effects & Dosage for.. 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. 2,3. The associated classic retinal toxicity is described as a bull’s eye maculopathy ring of depigmented retinal pigment epithelium that spares the foveal area. Many patients treated with hydroxychloroquine receive a dosage that exceeds the recommended maximum, boosting the retinal damage risk. Plaquenil hydroxychloroquine belongs to a group of medicines called quinolines. Plaquenil is used to treat or prevent malaria, a disease caused by parasites that enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia.