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. Plaquenil brittle hair Combination methotrexate and plaquenil Plaquenil inflammatory arthritis 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. The biggest difference between the. An audit of 100 patients seen at any of nine Canadian rheumatology clinics during early 2016 showed that 30% of patients were not on appropriate weight-based hydroxychloroquine dosages, and 13% of patients on the drug had not received a baseline retinal assessment during their first year. Doses ≥ 5 mg/kg/day real weight of hydroxychloroquine 2.3 mg/kg/day of chloroquine are associated with higher risk of toxicity. Doses lower than 5 mg/kg/day have low risk 1% for the first 5 years, and below 2% between 5-10 years of use. 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. Retinal toxicity dosage hydroxychloroquine Hydroxychloroquine Professional Patient Advice -, Hydroxychloroquine dosage recommendations often ignored. Chloroquine resistance wikiPlaquenil maculopathy oct of maculaChances of having a lupus flare when stopping plaquenilPlaquenil mefloquine Background/Purpose Hydroxychloroquine HCQ is a widely-used medication in many rheumatologic conditions. The most worrisome toxicity is irreversible damage to retinal pigment epithelium which can lead to blindness. The most recent 2016 guidelines from the American Academy of Ophthalmology AAO recommend the dose of HCQ ≤5 mg/kg real body weight to minimize toxicity1. According to these New Guidelines on Hydroxychloroquine Dosage - Where Are We.. Hydroxychloroquine And Chloroquine Screening 2016 AAO Recommendations.. New Guidelines on Hydroxychloroquine Dosage - Where Are We? - ACR.. Factors that increase the risk of developing hydroxychloroquine associated retinal toxicity include daily dose, cumulative dose, renal or liver impairment, older age, and prior retinal disease. Specifically, a daily dose of 6.5mg/kg based on ideal body weight and a cumulative dose of 1000g of hydroxychloroquine or 460g of chloroquine are both considered risk factors for retinal toxicity. Newer guidelines state that daily dose 5mg/kg of real weight/day can lead to toxicity. Retinal toxicity is irreversible and can progress after cessation of hydroxychloroquine, thus early screening is important to limit potential vision loss. Baseline screening and annual screening after five years is recommended. The toxic dosage for chloroquine was derived from hydroxychloroquine retinal toxicity studies, although no definitive data have shown pharmacologic equivalence. 1 The first reports of retinal toxicity attributed to chloroquine appeared during the late 1950s.