Select one or more newsletters to continue. I think SD-OCT scans with broad coverage are a good screening method for Asian patients.”And a patient’s self-reported symp­toms also cannot serve as a reliable guide to the extent of damage, Dr. Kim said. Marmor and Melles found that 50% of California patients of Asian heritage who had HCQ retinopathy showed degenera­tive changes near the vascular arcades rather than in the “typical” parafoveal region (and another 30% showed a mix of parafoveal and pericentral damage).“Pericentral retinal damage seems more common in Asian patients,” com­mented Sang Jin Kim, MD, a coauthor of the 2017 study. 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.The action of hydroxychloroquine is cumulative and may require weeks to months to achieve the maximum therapeutic effect (see Do not exceed 600 mg or 6.5 mg/kg (5 mg/kg base) per day, whichever is lower, as the incidence of retinopathy has been reported to be higher when this maintenance dose is exceeded.Corticosteroids and salicylates may be used in conjunction with PLAQUENIL, and they can generally be decreased gradually in dosage or eliminated after a maintenance dose of PLAQUENIL has been achieved.Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Do not take antacids or kaolin within 4 hours of Plaquenil (hydroxychloroquine). 6 Newer literature emphasizes the risk of cumulative dosing that occurs over a period of time (>1,000g) rather than the … However, serum drug levels should only be taken when there is a clear indication to Most Viewed content is not available.

Dosage greater than 5.0mg/kg over five years dramatically increases the risk of retinal toxicity, and high doses can be exceedingly dangerous. Moreover, it is used as an adjunct in chemotherapy, and it is being investigated as a treatment for diabetes and heart disease, thanks to its anti-inflammatory, lipid-lowering, and antithrombotic properties.But as ophthalmologists know, excessive HCQ dosages can result in toxic damage to the eye. My husband prefers I do not use the prednisone. These were updated in 2011 and again last year.Here’s an overview of the latest guidelines—and troubling evidence that far too many patients are still receiving too high a dose of HCQ (see “Highlights of the 2016 guidelines in­clude the following.This represents a significant change from the 2011 guidelines, which recom­mended using ideal body weight to determine dosages. As a practical bonus, the guideline of 5 mg/kg is much easier to calculate, he added.Patients who have been taking HCQ for 5 or more years are at increased risk of developing HCQ retinopathy, even if they have no other risk factors. “We haven’t the foggiest idea,” Dr. Marmor said. Even though 4 of the 9 patients with HCQ retinopathy in his study had advanced damage, “only 1 of the 9 patients complained of visual distur­bances at the time of diagnosis.”The main point of the revised guidelines is that “you want to get people on the right dose,” Dr. Marmor said. “The bottom line is that the daily dose should be 5.0 mg per kg or less, using real body weight,” said Michael F. Marmor, MD, at Stanford University in Palo Alto, Calif. Multiple reports demonstrate that concomitant use of hydroxychloroquine and azithromycin can prolong the QTc interval; 17-19 in an observational study, the use of hydroxychloroquine plus azithromycin was associated with increased odds of cardiac arrest.

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