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 hot flashes Hydroxychloroquine mechanism of action lupus Hydroxychloroquine monitoring ophthalmology Plaquenil dosage for malaria These recommendations are based primarily on one retrospective cohort study that reported a much higher prevalence of HCQ retinopathy 7.5%, n = 2361 than previously observed 0.5–2.0%. Incidence of hydroxychloroquine retinopathy in 1,207 patients in a large multicenter outpatient practice. Of retinopathy, as a result of long term use of hydroxychloroquine. Evidence suggests the prevalence of hydroxychloroquine retinopathy has been underestimated and recommends a hospital based screening programme for patients to provide assurance that current treatment regimens are within safe parameters. Results Real body weight predicted risk better than ideal body weight and was used for all calculations. The overall prevalence of hydroxychloroquine retinopathy was 7.5% but varied with daily consumption odds ratio, 5.67; 95% CI. 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. Hydroxychloroquine retinopathy prevalence The risk of toxic retinopathy in patients on long-term., Hydroxychloroquine and Retinal Screening Plaquenil dose toxicity Hydroxychloroquine HCQ retinopathy is of concern because of the potential seriousness of visual loss and the medicolegal consequences of failure to detect toxicity. However, there have been limited demographic data on which to base recommendations for screening. Rates and Predictors of Hydroxychloroquine Retinal.. Toxic Retinopathy With Hydroxychloroquine Therapy - JAMA. New Plaquenil Guidelines. Abstract Background The American Academy of Ophthalmology recommendations on screening for chloroquine CQ and hydroxychloroquine HCQ retinopathy are revised in light of new information about the prevalence of toxicity, risk factors, fundus distribution, and effectiveness of screening tools. Hydroxychloroquine retinal toxicity is far more common than previously considered; an overall prevalence of 7.5% was identified in patients taking HCQ for greater than 5 years, rising to almost 20. This large retrospective study of hydroxychloroquine users found a prevalence of hydroxychloroquine retinopathy three times higher than previously reported, but the risk was highly dependent on dosage and duration of use.