Because early toxicity changes can be revealed on SD-OCT, it is prudent to perform a baseline screening of patients taking Plaquenil. Multifocal ERG has the ability to detect early macular dysfunction, so it should be included as part of baseline screening. A maximum daily dose of Plaquenil of 5. 0mg/kg real weight is recommended. Communication with the prescribing physician is also key to proper treatment and management of your patient. Plaquenil (hydroxychloroquine sulfate, Sanofi-Aventis) and the less-used chloroquine are antimalarial drugs with anti-inflammatory properties that are used for the management of a spectrum of inflammatory conditions.
How do I store and/or throw out Hydroxychloroquine?
Plaquenil is less toxic than chloroquine; however, long-term use of either drug can result in macular toxicity, leading to devastating irreversible vision loss. The mechanism of this toxicity is not clearly understood, though it is believed that the drug molecule binds to melanin in the retinal pigment epithelium (RPE). Earlier literature on the prevalence of CQ or HCQ retinopathy included few patients on long-term therapy and only recognized severe toxicity (bull’s-eye changes). Daily dose (more properly, daily use, as measured by actual pharmacy dispensing) was the most critical determinant of risk, and the risk was more closely correlated with real weight than ideal weight. Very thin patients in particular are at increased risk when dose is calculated by ideal weight (as previously recommended). It is now being considered for new applications in diabetes mellitus, heart disease, and adjunct cancer therapy. Thus, it is important for ophthalmologists and other physicians to understand the prevalence and risk factors for retinopathy. Hydroxychloroquine (Plaquenil) is an anti-malarial medication used for a variety of inflammatory diseases including systemic lupus erythematosus as well as rheumatoid arthritis and Sjogren’s Syndrome. Hydroxychloroquine is contraindicated for Marshall ProtocolA curative medical treatment for chronic inflammatory disease.
- Unfortunately, clinically evident early structural changes can be subtle and usually preceded by abnormalities in functional tests such as visual field examination, multifocal electroretinography (mfERG), fundus autofluorescence (FA) imaging, and optical coherence tomography.
- If you are taking Plaquenil to treat an inflammatory condition or malaria, you should be aware of the side effects that may occur to your eyes and vision.
- Most critical is fundus evaluation of the macula to rule out any underlying disease that might make use of these drugs unwise because of preexisting tissue damage or interference with the interpretation of screening tests.
- Plaquenil (hydroxychloroquine sulfate, Sanofi-Aventis) and the less-used chloroquine are antimalarial drugs with anti-inflammatory properties that are used for the management of a spectrum of inflammatory conditions.
Patients in this new study2 mostly had been prescribed routine doses of HCQ by prior standards, but the average use was approximately 5. 0 mg/kg of real weight because of varying compliance and body habitus. Thus, 5. 0 mg of HCQ/kg real weight corresponds with present medical prescription practices and should be therapeutically effective for most patients. Visual acuity usually is excellent with either pattern until severe stages of damage, and most patients who develop HCQ toxicity have no visual symptoms at all. A few perceptive patients may notice paracentral scotomas while reading. Hydroxychloroquine is generally prescribed at a daily dose of 6. 5 milligrams (or less) per kilogram of body weight. We describe the case of an elderly person with elderly-onset rheumatoid arthritis (RA), where the use of therapeutic doses of HCQ was followed by the appearance of psychomotor agitation. Several risk factors may increase the likelihood of retinal toxicity from Plaquenil such as, age of greater than 60 years, daily dose more than 6. 5 mg/kg; use of the drug more than 5 years, obesity, preexisting retinal disease and, renal or liver failure. Early detection Rapid Test kit of the maculopathy is of critical importance to discontinue Plaquenil in order to stop or slow retinal damage. Unfortunately, clinically evident early structural changes can be subtle and usually preceded by abnormalities in functional tests such as visual field examination, multifocal electroretinography (mfERG), fundus autofluorescence (FA) imaging, and optical coherence tomography. What tests do you need to perform during their baseline screening?
High Risk Medications
Hydroxychloroquine (HCQ) is a synthetic antimalarial drug derived from 4-aminoquinoline; it has been used for several decades for the treatment of some rheumatic diseases such as rheumatoid arthritis (RA). A dosage between 3 and 6 mg/bodyweight/day is considered therapeutic. In obese individuals, the dosage must be assessed considering the patient’s ideal bodyweight. Hydroxychloroquine may potentially result in adverse effects on the central nervous system, mainly irritability, nervousness, emotional changes, nightmares, and even true psychoses.