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. Areas of chloroquine resistant malaria What is the best time to take plaquenil 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. Symptoms and SignsMechanism of ToxicityMedication DosageRisk For ToxicityMonitoring GuidelinesConclusion Rheumatologists use hydroxychloroquine sulfate Plaquenil, Concordia Pharmaceuticals to treat autoimmune diseases, namely discoid or systemic lupus erythematosus, rheumatoid arthritis, Sjögren syndrome, and malaria. When taken at high doses and for long durations, hydroxychloroquine has been known to cause parafoveal retinal 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. Plaquenil retinal testing guidelines Early Plaquenil Toxicity Detected without Bull’s Eye., Hydroxychloroquine-Induced Retinal Toxicity - American. Plaquenil 200 mg precioHydroxychloroquine and ldnWhat if i accidentally take 2 plaquenilPlaquenil reviews rheumatoid arthritis Retinal screening service will be provided by STH Ophthalmology department As patients are started on hydroxychloroquine, they will have a baseline retinal screen usually at 3 months but certainly within 12 months of starting, organised by the specialist. The specialist will also arrange a follow up retinal screen after 5 years Hydroxychloroquine and Retinal Screening. Retina Today - Imaging in Hydroxychloroquine Toxicity.. My Take on New Ocular Screening Guidelines for Plaquenil.. Screening guidelines were updated this year, with some pertinent changes for our profession to note. Cumulative dose is no longer a risk factor, The guidelines recommend starting annual screening after 5 years unless additional risk factors are present that include small stature, obesity, liver or kidney disease, and retinal disease. In these cases, test on an annual basis from the start. The AAO guidelines recommend that patients get a baseline examination within the first year of use and annual screening after 5 years of use, or earlier in higher-risk patients, that is, those on higher than recommended doses of HCQ, those taking HCQ 5 years, those with persistent renal or hepatic dysfunction, those who are obese, the elderly and those with pre-existing retinal and macular disease that may make it harder to screen for early changes.