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. Hydroxychloroquine monitoring bloods Generic plaquenil price increase Chloroquine prophylaxis Risk for toxicity is least with less than 6.5 mg/kg/day for hydroxychloroquine and 3 mg/kg/day for chloroquine. Patients are at low risk during the first 5 years of treatment. Cumulative use in excess of 250 grams increases the risk for toxic retinopathy. Other risk factors include obesity, kidney or liver disease, older age. Pigment dropout found in middle-aged man’s first eye exam. SD-OCT findings raised suspicion for chloroquine maculopathy. Chloroquine is actively used in Southeast Asia and Africa for malaria. Chloroquine and hydroxychloroquine belong to the quinolone family. They are related drugs with similar clinical indications for use and similar manifestations of retinal toxicity, although their therapeutic and toxic doses differ. 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. Chloroquine maculopathy cumulative dose Chloroquine-induced bull’s eye maculopathy, Pigment dropout found in middle-aged man’s first eye exam Reasons to take plaquenilHow long does plaquenil take to work for hivesPlaquenil and weedVisual prolem with plaquenilPlaquenil skin cancer Recent studies estimate that about 1% of patients develop toxic maculopathy after 5 years of treatment with plaquenil or chloroquine. The risk of maculopathy is associated with cumulative dose level of 1,000 grams and it usually takes 5-7 years for patients on the standard treatment of 250-400 milligrams per day to reach that level. H35.381-383 Toxic Maculopathy Of Retina - Decision-Maker PLUS. Chloroquine and Hydroxychloroquine Toxicity Practice.. Coronavirus cure Elon Musks proposes COVID-19 treatment.. The recommended adult dosage is 200 to 400 mg 155 to 310 mg base daily, administered as a single daily dose or in two divided doses. 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. A cumulative dose of 1000g of hydroxychloroquine or 460g of chloroquine was likely the largest risk factor, which was typically achieved after 5-7 years of a typical dosage 8, 10. However, there have been case reports of patients with hydroxychloroquine toxicity as early as 1.9 months after starting treatment 11. A woman aged 28 years with systemic lupus erythematous and abnormal kidney function, treated with 45 mg/kg hydroxychloroquine daily for 15 years cumulative dose 1369 g, presented with bilateral progressive central vision loss for 2 months. The patient had no known previous exposure to chloroquine. Best corrected visual acuity was 20/40 in her right eye and 20/30 in her left eye. Funduscopy.