New Plaquenil guidelines from the AMERICAN Academy of ophthalmology 2016

It is very important to calculate the best plaquenil/hydroxychloroquine dosage with a patient while you were in the room together because of often patients are overdosed. Here are the recommended guidelines.

Sandra Lora Cremers, MD, FACS 

2016 AAO American Academy of ophthalmology recommendations
Dose
• Maximum daily HCQ use of <=5.0 mg/kg real weight.

Duration
At recommended dosage, risk of toxicity up to 5 years is under 1% and up to 10 years is under
2%... BUT 20% AFTER 20 YEARS.

Risk factors:
Concomitant renal disease
*Subnormal glomerular filtration rate
*Concomitant Drugs
•Tamoxifen Use

Maculopathy is NOT reversible and damage may progress even after drug cessation.

Since this patient is on Hydroxychloroquine, we recommend the following:

1. Real Body Weight be used to calculate proper dose (see eyedoc2020@blogspot.com for reference).
2. No more than 5.0 mg/kg actual body weight to decrease risk of maculopathy.
3. If dosing is calculating 300mg/day, an alternate dosage is recommended: Average the dose over 2-3 days.

Ophthalmologists recommend the following yearly eye screening:
1. Baseline Screening within first year of use
2. Annual screening after 5 years of use with Humphrey Visual Field: Humphrey Visual Field (10-2). For Asian patients, 24-2 or 30–2 as maculopathy affects their peripheral macular first
3. Spectral Domain OCT: Annually especially if HVF has any defect.
4. If we have any suspicion of damage, we will request a Multifocal ERG and Fundus Autofluorescence. Please let us know if your patient has any history of Kidney Disease or is taking Tamoxifen Citrate which increases the risk of retinal toxicity. Prevalence of retinal toxicity with 4.0-5.0mg/kg daily dose is 2% within 10 years and 20% after 20 years


The AAO noted the following for high risk for Hydroxychloroquine retinal toxicity:
1. >1kg HCQ
2. >5yr use but 20% at 20yrs.
3. Increased age, renal disease, liver disease
4. >5mg HCQ/kg actual body weight/day