She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Hydroxy chloroquine What does plaquenil do to your eyes Medicine reactions between plaquenil and xolair Can i take cipro while taking plaquenil The cumulative dose of Chloroquine was previously considered to be of significance as a risk factor for development of maculopathy. This was contradicted by recent studies that suggested that the daily intake adjusted to lean ideal body weight actual body weight—body fat is a more important risk factor 14, 25, 26. Recent studies estimate that about 1% of patients develop toxic maculopathy after 5 years of treatment with plaquenil or chloroquine. The risk of maculopathy is associated with cumulative dose level of 1,000 grams and it usually takes 5-7 years for patients on the standard treatment of 250-400 milligrams per day to reach that level. This cumulative dose is created when the common dose of 400 mg/day is used for 6.8 years. Hydroxychloroquine is metabolized and secreted by both the liver and the kidneys. Therefore, disturbed renal or hepatic function might reduce HCQ clearance and increase the propensity for toxicity. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Chloroquine maculopathy cumulative dose Recommendations on Screening for Chloroquine and., H35.381-383 Toxic Maculopathy Of Retina - Decision-Maker PLUS Cutting plaquenil in half causing dosing errorsHonduras chloroquine sensitivePlaquenil and prednisone will i lose weight or gain weightChloroquine thailand malaria The revised CQ and HCQ retinopathy screening recommendations of AAO stated that high-risk patients were those who used CQ longer than 5 years, or those who had a cumulative dose 460 g or a daily dose 250 mg/d or 2.3 mg/kg real weight/d, or those who were elderly or had concurrent liver or renal dysfunction.3,4 This current study seemed to agree with the recommendations that the elderly are at higher risk than younger patients, but the median age was less than 60 years. Incidence of and risk factors for chloroquine and.. Retinal Physician - Hydroxychloroquine Maculopathy An.. Revised Recommendations on Screening for Chloroquine and.. The recommended adult dosage is 200 to 400 mg 155 to 310 mg base daily, administered as a single daily dose or in two divided doses. Doses above 400 mg a day are not recommended. The incidence of retinopathy has been reported to be higher when this maintenance dose is exceeded. Most cases of chloroquine retinopathy have developed when a higher than currently recommended 3 mg/kg/day using lean body weight dose was used. 21 A daily dose exceeding 250 mg with a total cumulative dose between 100 and 300 g is customarily needed to produce toxicity. 22 One study showed a 19% incidence of chloroquine retinopathy in patients taking a mean daily dose of 329 mg. 23 On the other hand, with strict adherence to a low dose per day, the incidence of retinal abnormalities is. Dose equivalence and conversion. Doses expressed as chloroquine base. Each tablet contains 155 mg of chloroquine base equivalent to 250 mg of chloroquine phosphate. Syrup contains 50 mg/5 mL of chloroquine base equivalent to 80 mg/5 mL of chloroquine phosphate.