Most importantly, you help support continued development of this site. The majority of cases of retinotoxicity have occurred 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). Hydroxychloroquine effectiveness rheumatoid arthritis Mosquitos and plaquenil Plaquenil sleep problems Hydroxychloroquine Plaquenil is used to treat malaria, lupus, and rheumatoid arthritis. Learn about side effects, warnings, dosage, and more. The dosage is based on body weight. 6.5 mg/kg. On the basis of a recent study of 2,361 long-term HCQ users, 3 the Academy now recommends that all patients using HCQ keep daily dosage less than 5.0 mg/kg actual body weight—not ideal body weight,” said Dr. Marmor. “Older recommendations once advised calculating dosage as 6.5 mg/kg ideal body weight, but that conclusion was based on. However, since Mackenzie’s time, there have now been multiple reported cases of hydroxychloroquine retinopathy in patients who developed retinopathy despite taking less than 6.5 mg/kg/d based on IBW, not ABW.4,27,30,31,33 Therefore, 6.5 mg/kg/d based on IBW has been transformed from the threshold for safe dosing to the threshold for toxic dosing. It now solely uses real body weight (rather than ideal body weight) based on new recommendations from a 2014 study (1). Disclaimer: This tool is designed to help eye care professionals better understand the risk the of retinotoxicity from hydroxychloroquine. Please note: This calculator was modified in 9/2015. Hydroxychloroquine weight based dosing 5 mg kg ideal bo Hydroxychloroquine prescription trends and predictors for excess dosing., New App to Tackle Hydroxychloroquine Dosing Dilemma. How do i stop taking plaquenilAct with chloroquine tenafqineMethotrexate and plaquenilHydroxychloroquine generic brands 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. New Guidelines on Hydroxychloroquine Dosage - Where Are We? - ACR.. The impact of different algorithms for ideal body weight.. The Role of Hydroxychloroquine Blood Levels in SLE RheumNow.. Again, calculating "safe" daily plaquenil dosage for this weight 66.02 kg * 6.5 mg/kg/qd = 429 mg. As expected, it indicates a higher "safe" dosage 429 vs 356mg than the calculation using ideal body weight for this height. For the last time, let's graph this relationship to get a look at the big picture If a patient is on a dose that exceeds 5 mg/kg/day of real body weight, the prescribing physician should be contacted to ensure that the dose can be adjusted and medical risks are managed. Content Contributors Based on these risks, the American Academy of Ophthalmology AAO recommends not exceeding a daily hydroxychloroquine dosage of 5 mg/kg using actual body weight in most patients. Previous recommendations to use ideal body weight are no longer advised; very thin patients in particular were at increased risk for retinal toxicity using this practice.