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. Eye toxicity hydroxychloroquine Plaquenil uptodate Hydroxychloroquine Plaquenil is a commonly used medication in the management of various rheumatic diseases. Standard doses used by rheumatologists are 200mg to 400mg per day. Although serious toxicity with hydroxychloroquine is very unusual, the most important is retinal toxicity. The risk of toxicity is low for individuals without complicating conditions during the first 5 years of treatment using less than 6.5 mg/kg/day of hydroxychloroquine or 3 mg/kg/day of chloroquine, and/or cumulative doses of less than 1000 gram and 460 gram total dose, respectively. Daily dose greater than 400 mg or, in people of short stature, a daily dosage over 6.5 mg/kg ideal body weight or total cumulative dose of more than 1,000 g ; medication use longer than five years ; concomitant renal or liver disease because the drug is cleared by both routes underlying retinal disease or maculopathy ; age greater than 60 years. 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. Hydroxychloroquine retinopathy cumulative dose Case Report Hydroxychloroquine Retinopathy Optometry and., Chloroquine retinopathy - Wikipedia Plaquenil cost at rite aidHydroxychloroquine pneumococcal vaccineCan plaquenil cause swelling of mouthDrugs used to treat chloroquine resistant malariaChloroquine hemozoin falciparum While there have been reported cases of hydroxychloroquine toxicity at cumulative doses similar to our patient’s 1460 g over a 10 year period, these patients had 1 received chloroquine therapy before hydroxychloroquine therapy, 2 were treated with daily doses 400 mg/day, or 3 exceeded a daily dosage of 6.5 mg/kg of body weight/day.2 Our patient’s daily dose never exceeded 400 mg/day or 6.3 mg/kg of body weight/day. Her renal function was normal, thereby making the possibility of. Retinopathy after long term, standard doses of.. Hydroxychloroquine-Induced Retinal Toxicity - American.. Plaquenil Risk Calculators. A cumulative dose of 1000g of hydroxychloroquine or 460g of chloroquine was likely the largest risk factor, which was typically achieved after 5-7 years of a typical dosage 8, 10. However, there have been case reports of patients with hydroxychloroquine toxicity as early as 1.9 months after starting treatment 11. Major risk factors for hydroxychloroquine-induced retinopathy include a cumulative dose of more than 1000 g, 3 a daily dose of more than 6.5 mg/kg, 3 duration of treatment longer than five years, 9 development of age-related changes to the eye, 10 pre-existing retinopathy, 7 kidney or liver disease, 4 and concurrent use of tamoxifen. 4 Hydroxychloroquine retinopathy is most influenced by daily dose, length of use, and cumulative dose over time. Risk for toxicity is least with less than 6.5 mg/kg/day for hydroxychloroquine and 3 mg/kg/day for chloroquine.