Abstract
Hydroxychloroquine sulfate (Plaquenil®) is prescribed for the treatment of rheumatoid arthritis, discoid and systemic lupus erythematosus, and other predominantly autoimmune diseases. Use of this systemic antimalarial drug has been associated with retinotoxic effects that can produce visual acuity and visual field loss. The literature suggests that if the dosage of hydroxychloroquine is less than 6.5 mg/kg of body weight per day, treatment duration is less than 10 years, and the patient does not have kidney disease, the risk of retinopathy is nonexistent. This view is clearly at odds with the stringent monitoring regimen recommended by the manufacturer of Plaquenil®. This paper reviews the literature on the risks of hydroxychloroquine retinopathy and how these risks should be managed. Reported cases of retinopathy and recommendations on frequency of follow-up, appropriate testing, and the role of self-monitoring will be discussed. Based upon a review of the recent literature, monitoring guidelines for hydroxychloroquine retinopathy will be suggested.
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