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. Hydroxychloroquine and breastfeeding Cheapest brand plaquenil A cumulative dose of 1000g HCQ is reached in 7 years with a typical daily dose of 400 mg. In the same study, toxicity was not related to age, weight or daily dose but was related to duration of use and increased rapidly after 5 to 7 years; thus, it is important to be aware of the risk factors and use more effective protocols of screening on all the patients who exceed 5 years of exposure. Plaquenil-induced maculopathy is a form of retinal toxicity that is associated with long-term use of of the anti-inflammatory medication plaquenil. The drug-induced maculopathy is associated with the following risk factors Cumulative dose level of 1,000 grams of plaquenil; Patients with existing retinal or macular disease; Patients over the. Adults 800 mg 620 mg base followed by 400 mg 310 mg base at 6 hours, 24 hours and 48 hours after the initial dose total 2000 mg hydroxychloroquine sulfate or 1550 mg base. 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. Plaquenil toxicity cumulative dose Plaquenil Toxicity -, Plaquenil-Induced Toxic Maculopathy - Decision-Maker PLUS Is hydroxychloroquine an anti malarial medicationPlaquenil and skin issuesOsteo bi-flex triple strength and plaquenil The same study revealed that the most important predictor of toxicity was the duration of use cumulative dose and that age, the daily dose, and patient weight did not correlate significantly with HCQ toxicity. One reaches a cumulative dose of 1000 grams 1 kilogram at 7 years when taking the most commonly prescribed dose of 400 mg a day. Chloroquine And Hydroxychloroquine Toxicity - StatPearls.. Plaquenil Dosage Guide -. Early Plaquenil Toxicity Detected without Bull’s Eye Maculopathy. There is an increased risk of HCQ retinopathy with increase in the cumulative dose. Per the prior 2011 AAO guidelines the recommended maximum dose to minimize HCQ retinal toxicity was 6.5 mg /kg based on ideal body weight 2. The advantage of the real body weight formula is that it distributes the risk evenly on a broad range of body habitus. 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. 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.