Chloroquine is now uncommonly used in favor of its derivative hydroxychloroquine. In the United States, hydroxychloroquine is most often used for its anti-inflammatory effects in rheumatology and dermatology. Hydroxychloroquine for dermatomyositis Plaquenil mouth sores The AAO published dosing and screening recommendations for chloroquine and hydroxychloroquine in 2016, revising previous recommendations published in 2011. 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. Up to half of patients treated with the arthritis drug hydroxychloroquine Plaquenil are prescribed more than the recommended maximum amount, according to new research. In separate studies, Canadian and U. S. researchers found that 30 to 50 percent of patients didn’t receive the dose outlined in treatment guidelines; a smaller percentage didn’t get recommended eye exams. Hydroxychloroquine And Chloroquine Screening 2016 AAO Recommendations The American Academy of Ophthalmology released an updated set of screening recommendations for hydroxychloroquine Plaquenil and chloroquine to account for the many studies that have shown the effects of these medications on the retina 1. While early toxicity may be asymtomatic, patients with more advanced stage of toxicity may complain of color vision changes or paracentral scotomas. Its toxic effects on the retina are seen in the macula. Plaquenil 2016 retina Hydroxychloroquine-Induced Retinal Toxicity - American., Wrong Hydroxychloroquine Dose Is Common, Putting Eyes at Risk. Act with chloroquine tenafqineContraindications plaquenil and baking sodaHydroxychloroquine plaquenil mechanism of actionPlaquenil maculopathy photos Posterior exam showed 1+ nuclear sclerosis of the lenses OU. Vitreous was clear of cell OU. Fundus exam showed OD and OS optic nerves were pink and distinct with a 0.15/0.15 cup-to-disc ratio. The macula in each eye exhibited a flat appearance with absent foveal reflexes. Peripheral retina was unremarkable OU. Determine risk for hydroxychloroquine retinal toxicity.. Hydroxychloroquine And Chloroquine Screening 2016 AAO.. Hydroxychloroquine - Wikipedia. However in 2016, the price dramatically increased from ~ $0.16 to $6 per pill. Cost of biologic is ~$4000 for 40mg Humira for a 2 week dose Retinal toxicity is fairly rare. how rare is a big question Rheumatologists LOVE Plaquenil. SO MUCH LOVE. The most common side effects are nausea and diarrhea, which Chloroquine and hydroxychloroquine bind to melanin in the retinal pigment epithelium RPE and cause damage to the macular cones outside of the fovea. The drugs inhibit RPE lysosome activity, reduce phagocytosis of shed photoreceptor outer segments causing an accumulation of outer receptor segments. The classic finding is a bulls eye maculopathy--loss of the vision in a circle around the very center of sight. The problem with this vision loss is that it is not reversible, and it can sometimes progress for a period of time even after the plaquenil is stopped.