Although their therapeutic and toxic doses differ, they are related drugs with similar clinical indications for use and similar manifestations of retinal toxicity. The image below depicts hydroxychloroquine retinopathy. Fluorescein angiogram of left macula in patient with hydroxychloroquine retinopathy. Side effects bruising methotrexate plaquenil Plaquenil 200mg ilaç Sjogrens plaquenil available Plaquenil 200mg turkey Jan 05, 2020 Hydroxychloroquine retinopathy is most influenced by daily dose and duration of use. Risk for toxicity is less with 5.0 mg/kg real weight/day for hydroxychloroquine and 2.3 mg/kg real weight/day for chloroquine. Patients are at low risk during the first 5 years of treatment. All of the diagnostic test results confirmed the initial diagnosis of early retinal toxicity from plaquenil therapy. Photographic documentation of the macula would be an additional medically necessary test that could be obtained at any follow up evaluation. Additionally, color vision––helping in the assessment of macular integrity––was recommended as an optional test. There have been reports of color vision defects associated with chloroquinine- and hydroxychloroquinine-related retinal toxicity. 4 Other optional tests included multifocal electrophysiology mfERG testing and fluorescein. Retinopathy may be asymptomatic or may cause central or paracentral scotomas leading to difficulty reading or performing fine visual tasks (due to parafoveal metamorphopsia). Reprinted from American Journal of Ophthalmology, Vol 104, Johnson and Vine, Hydroxychloroquine therapy in massive total doses without retinal toxicity, pages 139-144, Copyright 1987, with permission from Elsevier Science. Color dx test results in plaquenil toxicity Chloroquine and Hydroxychloroquine Toxicity Practice., Plaquenil-Induced Toxic Maculopathy - Decision-Maker PLUS Plaquenil maculopathy dosage Of course the aim is avoid drug related retinal toxicity, which on ophthalmic examination, appears as the classic Bull’s eye change affecting the macula. Once retinal toxicity from hydroxychloroquine occurs, it is thought that the retinal changes are permanent and the disease can progress even if hydroxychloroquine is stopped for 1 to 3 years. My Take on New Ocular Screening Guidelines for Plaquenil.. New Plaquenil Guidelines. Rx Side Effects New Plaquenil Guidelines and More - American.. The American Academy of Ophthalmology released an updated set of screening recommendations for hydroxychloroquine Plaquenil and chloroquine to account for the many studies that have shown the effects of these medications on the retina 1. It succinctly makes the case for screening, and Physician’s order e.g. Extended color vision testing to rule out Plaquenil macula toxicity – patient unable to complete 10-2 HVF Reliability of the test e.g. Prompt responses Findings e.g. Some red-green defects noted OU Assessment, diagnosis e.g. Plaquenil macula toxicity OU; no prior hx of color vision defects The usual starting dose of Plaquenil is 200 mg twice a day or 400 mg once a day, administered orally, in people weighing 80 kg or more. The usual dosage works for most people who take Plaquenil, but it is possible to increase or decrease the dose based on individual needs. It's important to watch for possible side effects and toxicity.