Her rheumatologist instructed her to undergo a baseline ocular examination prior to initiating Plaquenil (hydroxychloroquine, Sanofi-Aventis) therapy. Toxic maculopathy associated with chloroquine use was first documented in the literature five decades ago.1 In the United States, Plaquenil––an analog to chloroquine––is used to treat a variety of conditions, including rheumatoid arthritis, lupus and several distinct inflammatory disorders. Although the incidence of macular toxicity is infrequent with Plaquenil use (at a dosage of 200mg or 400mg q.d.), its visual impact can be devastating. Hydroxychloroquine tiredness Stomach digestion meditcation plaquenil Plaquenil for sarcoidosis Mechanism of Toxicity. The mechanism of hydroxychloroquine retinal toxicity has yet to be fully elucidated. Studies have shown that the drug affects the metabolism of retinal cells and also binds to melanin in the RPE, which could explain the persistent toxicity after discontinuation of the medication. Tehrani R, Ostrowski RA, Hariman R, Jay WM Ocular toxicity of hydroxychloroquine. Semin Ophthalmol 2008, 233201-209. Marmor MF, Kellner U, Lai TY, Lyons JS, Melles RB, Mieler WF Recommendations on screening for chloroquine and hydroxychloroquine retinopathy 2016 Revision. Ophthalmology 2016, 186-1394. Hydroxychloroquine and Ocular Toxicity Recommendations on Screening. The Royal College of Ophthalmologists in association with The British Society for Rheumatology and the British Association of Dermatologists, 2009. Initially, central visual acuity may be unaffected, but the patient may notice related paracentral scotomas that often interfere with reading. The associated classic retinal toxicity is described as a bull’s eye maculopathy (ring of depigmented retinal pigment epithelium that spares the foveal area). Hydroxychloroquine and ocular toxicity recommendations on screening 2009 New Guidelines for Hydroxychloroquine Visual Screening, Hydroxychloroquine Plaquenil Toxicity and. Is plaquenil safe to take during pregnancyNo need to check g6pd level for plaquenilPlaquenil testing optometryChloroquine autophagy concentrationPlaquenil boils Introduction. Chloroquine CQ and its chemical analogue hydroxychloroquine HCQ -known as antimalarial drugs- have been used commonly since 1950s for the treatment of various autoimmune rheumatic diseases. The efficacy and toxicity of HCQ are lower than those of CQ. Ocular toxicity induced by these drugs was first described in 1957. These drugs are eliminated from the body very slowly. A New Objective Parameter in Hydroxychloroquine-Induced.. Hydroxychloroquine-related retinal toxicity Rheumatology.. Hydroxychloroquine and ocular toxicity recommendations.. Sep 15, 2014 Hydroxychloroquine sulfate HCQ, Plaquenil is an analogue of chloroquine CQ, an antimalarial agent, used for the treatment of systemic lupus erythematosus, rheumatoid arthritis and other autoimmune disorders. Its use has been associated with severe retinal toxicity, requiring a discontinuation of therapy. Screening recommendation. Guidelines and recommendations for screening for retinal toxicity have evolved over the years. In 2002 the American Academy of Ophthalmology AAO first proposed screening recommendations for HCQ associated retinal toxicity, with the salient points being 14 1. Mar 15, 2019 Marmor MF, Kellner U, Lai TY, Melles RB, Mieler WF, American Academy of Ophthalmology. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy 2016 Revision. Ophthalmology. 2016 Jun. 123 61386-94. Mason CG. Ocular accumulation and toxicity of certain systemically administered drugs.