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. Generic drug for plaquenil Plaquenil staggered dose Im chloroquine Studies have shown that patients who have manifested with retinopathy have traces of Plaquenil metabolites in their erythrocytes, plasma, and urine even after 5 years of discontinuing the medication 1, 2, 3. Screening Recommendations. Because HCQ retinopathy cannot be reversed, proper screening is critical. The 2016 guidelines recommend the following. Screening intervals. All patients who are placed on long-term HCQ treatment should have a baseline screening within the first year of beginning treatment. Mar 02, 2018 The new guideline on screening for hydroxychloroquine and chloroquine retinopathy is written in response to evidence from the United States that shows that hydroxychloroquine retinopathy is more common than previously recognised. Implementation of the guideline’s recommendations will prevent iatrogenic visual loss. 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. Plaquenil retinopathy screening Protecting your eyesight when taking Plaquenil Lupus., Plaquenil Guidelines Point Out New Risks, New Presentation. Chloroquine dose for childHydroxychloroquine pharmacotherapyHydroxychloroquine for lupus nephritisWill hydroxychloroquine help autoimmune liver diseasePlaquenil and hpv Newer guidelines state that daily dose 5mg/kg of real weight/day can lead to toxicity. Retinal toxicity is irreversible and can progress after cessation of hydroxychloroquine, thus early screening is important to limit potential vision loss. Baseline screening and annual screening after five years is recommended. Hydroxychloroquine Plaquenil Toxicity and Recommendations.. RCOphth guideline Hydroxychloroquine and Chloroquine.. Plaquenil Screening - Retinal Diagnostic Center. Hydroxychloroquine HCQ, sold under the brand name Plaquenil among others, is a medication used for the prevention and treatment of certain types of malaria. Specifically it is used for chloroquine-sensitive malaria. Other uses include treatment of rheumatoid arthritis, lupus, and porphyria cutanea tarda. It is taken by mouth. BACKGROUND The American Academy of Ophthalmology recommendations for screening of chloroquine CQ and hydroxychloroquine HCQ retinopathy were published in 2002, but improved screening tools and new knowledge about the prevalence of toxicity have appeared in the ensuing years. The study findings revealed that when hydroxychloroquine was used at doses 5mg /kg, the risk of retinopathy was 1% in the first 5 yrs. 2% in 10 yrs. 20 % after 20 yrs. There was a dose response, such that those receiving doses greater that 5 mg / kg had the greatest risk of retinal toxicity.