Pattern of Retinopathy: Although the locus of toxic damage is parafoveal in many eyes, Asian patients often show an extramacular pattern of damage. Dose: We recommend a maximum daily HCQ use of 5.0 mg/kg real weight, which correlates better with risk than ideal weight. Hydroxychloroquine and trametinib Hydroxychloroquine 200 mg tab cost Plaquenil target Retinal toxicity plaquenil 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. Screening tests vary widely, and there is no gold standard test to definitively diagnose hydroxychloroquine toxicity. Guidelines recommend Humphrey visual field VF and spectral-domain OCT SD-OCT annually, along with multifocal electroretinography mfERG and fundus autofluorescence FAF as needed. Other FAF Applications In addition to traditional 10-2 threshold visual field testing, FAF is among the objective tools that may be used as part of the screening process for hydroxychloroquine maculopathy. A ring of hyper-autofluorescence along with parafoveal dark areas will be visible. Risk of Toxicity: The risk of toxicity is dependent on daily dose and duration of use. There are no similar demographic data for CQ, but dose comparisons in older literature suggest using 2.3 mg/kg real weight. Faf plaquenil screening New Plaquenil Guidelines, Retina Today - Imaging in Hydroxychloroquine Toxicity April 2019 Remove chloroquine phosphateChloroquine diphosphate solubilityChloroquine peak plasma concentrations And screening tests, but that screening begins after one year of therapy for all patients on chloroquine. Screening may be best incorporated into the hospital eye service via virtual clinics. The results of screening should be communicated back to the prescribing doctor, patient and GP as normal, possible or definite hydroxychloroquine retinopathy. Hydroxychloroquine and Chloroquine Retinopathy Recommendations on.. A Clinical Guide to Fundus Autofluorescence. Pause the Plaquenil?. Plaquenil is manufactured in only a 200 mg tablet The typical dosage is either 200 or 400 mg per day 200 mg daily puts anyone under 68 pounds at risk1 400 mg of Plaquenil daily puts anyone under 135 pounds at a higher risk for toxicity Therefore, 200mg of Plaquenil daily is going to be a safe dosage for virtually all adults13 The recent publication 2 of revised screening recommendations for hydroxychloroquine toxicity has raised awareness of objective modalities, such as multifocal electroretinography mfERG, spectral domain optical coherence tomography SD-OCT, and fundus autofluorescence FAF, as adjuncts or successors to the traditional visual field as screening tools. Screening intervals. All patients who are placed on long-term HCQ treatment should have a baseline screening within the first year of beginning treatment. An initial fundus evaluation of the macula is critical to rule out preexisting disease that might make the retina more susceptible or screening difficult.