One such commonly used medication for dermatologic and rheumatologic inflammatory conditions is hydroxychloroquine (Plaquenil), a chloroquine derivative. It is used to treat many diseases including malaria, rheumatoid arthritis and systemic lupus erythematosus. How does plaquenil work for sjogren's Plaquenil pain medication What if plaquenil doesn t work Hydroxychloroquine lupus side effects The American Academy of Ophthalmology has published several dosing and screening recommendations for hydroxychloroquine to avoid potential retinal toxicity, yet some patients still experience permanent vision loss resulting from hydroxychloroquine retinopathy due to improper dosing of the drug and improper screening. Plaquenil toxicity first affects small areas of the retina between 5° and 15° from the fovea. Figures 2 and 3 show three patients at different stages of toxicity. Figure 2 bottom right shows a color display of normal mfERGs. The amplitude of the mathematically derived b-wave of the mfERG is displayed in a color scale. SD-OCT images demonstrated loss of photoreceptor inner segment/outer segment IS/OS junction and a downward “sink-hole” displacement of inner retinal structures in areas of hydroxychloroquine toxicity corresponding to HVF 10-2 defects and ophthalmoscopic clinical examination findings. It is imperative that patients and physicians are aware of and watch for this drug’s ocular side effects. Retinal toxicity from hydroxychloroquine is rare, but even if the medication is discontinued, vision loss may be irreversible and may continue to progress. Oct appearance of plaquenil toxicity Plaquenil Toxicity Screening - Retina Group of New York, Retina Today - Evaluating Hydroxychloroquine Toxicity With Multifocal. Chloroquine mechanism in the body On examination, a telltale sign of hydroxychloroquine toxicity is a bilateral change in the retinal pigment epithelium of the macula that gives the commonly described appearance of a bull’s-eye. This is a late finding, however, and too late for screening to be useful. Hydroxychloroquine-Induced Retinal Toxicity - American.. Spectral-Domain Optical Coherence Tomography and Adaptive.. Plaquenil-Induced Toxic Maculopathy - Decision-Maker PLUS. Feb 19, 2020 SIDE EFFECTS. The following adverse reactions have been identified during post-approval use of PLAQUENIL or other 4-aminoqunoline compounds. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy Retinal toxicity from chloroquine CQ and its analogue, hydroxychloroquine HCQ, has been recognized for many years. Chloroquine toxicity remains a problem in many parts of the world, but is seen less frequently in the United States where the drug largely has been replaced by HCQ. The risk of a toxicity sharply increases after 5 years, with majority of cases of retinotoxicity occurring in patients that have had a cumulative dose exceeding 1000g of hydroxychloriquine Plaquenil. This level is reached in about 7 years with the most common daily dose of Plaquenil, 400 mg/day 200 bid.