Her rheumatologist instructed her to undergo a baseline ocular examination prior to initiating Plaquenil (hydroxychloroquine, Sanofi-Aventis) therapy. Toxic maculopathy associated with chloroquine use was first documented in the literature five decades ago.1 In the United States, Plaquenil––an analog to chloroquine––is used to treat a variety of conditions, including rheumatoid arthritis, lupus and several distinct inflammatory disorders. Although the incidence of macular toxicity is infrequent with Plaquenil use (at a dosage of 200mg or 400mg q.d.), its visual impact can be devastating. Plaquenil vs tacrolimus What happens when you stop plaquenil Patients taking hydroxychloroquine can demonstrate a toxic reaction in the retina despite the absence of known risk factors. Screening, including Humphrey 10-2 visual field assessment, is recommended 2 years after the initial baseline and yearly thereafter. Hydroxychloroquine or 250mg Chloroquine Dosage levels that can cause toxicity 6.5 mg/kg Hydroxychloroquine Plaquenil19 3 mg/kg Chloroquine Arlen With 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 Jan 05, 2020 Hydroxychloroquine is a well tolerated medication for various rheumatologic and dermatologic conditions. Its main side effects are gastrointestinal upset, skin rash, headache, and ocular toxicity. Within the eye, hydroxychloroquine negatively impacts the cornea, ciliary body, and retina. Initially, central visual acuity may be unaffected, but the patient may notice related paracentral scotomas that often interfere with reading. The associated classic retinal toxicity is described as a bull’s eye maculopathy (ring of depigmented retinal pigment epithelium that spares the foveal area). Visual defects hydroxychloroquine The Risk of Retinal Toxicity with Plaquenil, Early Plaquenil Toxicity Detected without Bull’s Eye Maculopathy Plaquenil lyme cysts Plaquenil and Visual field defect - a study from real-world data. Summary Visual field defect is found among people who take Plaquenil, especially for people who are female, 60+ old, have been taking the drug for 10+ years, also take medication Methotrexate, and have Osteoporosis. Will you have Visual field defect with Plaquenil - eHealthMe. Hydroxychloroquine toxicity - EyeWiki. How to interpret visual fields 5 most common patterns - EyeGuru. D. Visual field defects Pericentral or paracentral scotoma, central scotoma with decreased visual acuity, rarely field constriction. The most common visual symptoms attributed to the retinopathy are reading and seeing difficulties words, letters, or parts of objects missing, photophobia, blurred distance vision, missing or blacked out areas in the central or peripheral visual field, light flashes and streaks. Nov 18, 2011 Although visual field defects in HCQ toxicity can be highly variable in terms of the depth of defect, all our patients showed a similar pattern on 10-2 white, with the same areas affected. However, one needs to look carefully for subtle decreases in threshold in the area at risk 2–6 degrees from center. Side Effects Nausea, stomach cramps, loss of appetite, diarrhea, dizziness, or headache may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Remember.