Pattern of Retinopathy: Although the locus of toxic damage is parafoveal in many eyes, Asian patients often show an extramacular pattern of damage. Dose: We recommend a maximum daily HCQ use of 5.0 mg/kg real weight, which correlates better with risk than ideal weight. Chloroquine phosphate autophagy Plaquenil drug study The condition sometimes resembles a target, or bulls-eye ring, on the retina surrounding the macula. Hydroxychloroquine retinopathy is extremely rare and is most often seen in cases where the dosage is high or the patient has been taking it for several years. Bulls-eye maculopathy is uncommon, but when it does occur, it can be devastating visually. Jan 05, 2020 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. Bull’s-Eye Maculopathy Associated with Hydroxychloroquine A 60-year-old woman receiving long-term hydroxychloroquine presented to the eye clinic after noticing central blind spots in her visual. Risk of Toxicity: The risk of toxicity is dependent on daily dose and duration of use. There are no similar demographic data for CQ, but dose comparisons in older literature suggest using 2.3 mg/kg real weight. Hydroxychloroquine bull's eye maculopathy dosage Chloroquine-induced bull’s eye maculopathy, Hydroxychloroquine toxicity - EyeWiki Does hydroxychloroquine affect periodsPlaquenil toxicity in macular octChloroquine phosphate child's dosage malaria prophylaxisWhat is hydroxychloroquine sulfate 200 Apr 20, 2011 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. 2,3. The associated classic retinal toxicity is described as a bull’s eye maculopathy ring of depigmented retinal pigment epithelium that spares the foveal area. New Plaquenil Guidelines -. Bull’s-Eye Maculopathy Associated with Hydroxychloroquine NEJM. Bull's Eye Maculopathy – Causes, Complications, and Treatment.. A cumulative dose that increases the risk of retinal toxicity • 1000g total Hydroxychloroquine HCQ • 460 g total Chloroquine CQ Cumulative dose of 1000g HCQ is reached in 7 years with the daily dose of 400mg19 Cumulative dose of 460g CQ is reached in 5 years with the typical daily dose of 250mg19 We now know that bull’s-eye maculopathy is a late finding and may be associated with vision loss. Asians have a slightly different clinical presentation 3-4. Several recent studies have shown that instead of the classic perifoveal changes typical of hydroxychloroquine toxicity, Asians with retinal toxicity have a more peripheral pattern. In 1959, Hobbs established a link between long-term use of chloroquine and subsequent development of retinal pathology. In 1962, J Lawton Smith coined the term bull's eye maculopathy, regarded as the classic finding of macular toxicity.