|
Her
fundus findings, symptoms, and color vision testing as
well as fluorescein angiography all support Plaquenil (Hydroxychloroquine)
toxicity. Her total dosage of Plaquenil is about 1460
grams. Her daily dose was about 6.6mg/kg/day.
Both of these put her in a category with some risk.
We have seen several patients in the last month with
possible Plaquenil toxicity but these were older people
who had some degree of macular degeneration. This
lady has no reason for her RPE changes other than drug
toxicity.
Other
causes of bull’s-eye maculopathy include Chloroquine
toxicity; Cone Dystrophy; Pericentral RP; Stargardt’s;
Pattern Dystrophy
What
is the risk of plaquenil toxicity?
20 cases reported in 1,000,000 users
How
should Plaquenil patients be monitored?
If low dose, or <5 years use, no screening
If dosing is < 6.5mg/kg/day and duration < 6
years, then examine
no more than once per year. Otherwise every 6 months.
If progression “possible”, every 3 months
If
any real suspicion of toxicity, drug stoppage is
imperative, and damage may continue after stoppage
Examination:
Source: Recommendations on
Screening for Chloroquine and Hydroxychloroquine
Retinopathy - the American Academy of
Ophthalmology
http://www.acponline.org/sci-policy/guidelines/statement.pdf
To view previous cases,
please click below:
|
