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. Chloroquine phosphate 250 mg dosage Macrobid and hydroxy chloroquine interactions Plaquenil hydroxychloroquine belongs to a group of medicines called quinolines. Plaquenil is used to treat or prevent malaria, a disease caused by parasites that enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia. In 2002, the American Academy of Ophthalmology AAO established ocular examination guidelines for screening patients on Plaquenil therapy. Testing included a comprehensive eye exam that consisted of an assessment of the posterior segment with careful evaluation of associated macular changes or signs of retinal disease. 4 Baseline fundus photography was considered as an optional test. Lyons emphasizes the importance of annual screening and says that, although annual screening is recommended for everyone taking Plaquenil, it is imperative for people who have been taking the medication for more than 10 years, who have a higher incidence of retinal toxicity. Plaquenil-induced toxicity usually will not occur before five years of taking the drug. 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. Plaquenil retinal testing guidelines New Guidelines for Hydroxychloroquine Visual Screening, New Plaquenil Guidelines - Chloroquine chemo It has become fairly common practice for most rheumatologists to recommend that patients being treated with hydroxychloroquine be seen for formal visual field evaluation once or twice a year to monitor for retinal toxicity. The previous AAO guideline recommended screening every 12 months. My Take on New Ocular Screening Guidelines for Plaquenil.. Protecting your eyesight when taking Plaquenil Lupus.. Plaquenil Side Effects on Your Eyes and Vision. Cannot perform visual field testing, or in whom retinal imaging cannot be performed or images interpreted, a discussion between the patient and the prescribing physician is recommended to determine whether hydroxychloroquine treatment should be continued without retinal screening. GPP 2.4 Interpretation of Screening Results Criteria Level of The new guideline on screening for hydroxychloroquine and chloroquine retinopathy is written in response to evidence from the United States that shows that hydroxychloroquine retinopathy is more common than previously recognised. Implementation of the guideline’s recommendations will prevent iatrogenic visual loss. The current maximum daily HCQ dose recommended by the AAO is 5 mg/kg of real weight. The 2011 guidelines suggested a maximum dose of 6.5 mg/kg of ideal weight. The biggest difference between the.