According to the Amercian Academy of Ophthalmology 2017 guidelines, the dosage of Plaquenil should be adjusted for patient weight. Patients with lower weight may be at increased risk of retinal damage over time if treated with unadjusted dosing schedules. Other researchers emphasize the importance of dosing by height as well. The PDF document below may be downloaded and used as a reference guide. Please note that if a patient has kidney disease or liver disease the dose may need to be reduced by one half.
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Hydroxychloroquine (Plaquenil) and your eyes
What side effects can Plaquenil have in the eye?
Although Plaquenil is of proven benefit for a number of medical problems, very rarely it can cause damage to the eyes (1-2% at 10 years and 3-20% at 20 years). Early symptoms may be subtle. Small blind spots may develop just above or around the center of vision. Sometimes they progress to form a doughnut-shaped blind area around the central vision. If not detected early, the central vision itself may be lost. When this occurs, color vision is usually affected. These symptoms, however, are not specific to Plaquenil damage. The Eye MD must use special tests to determine whether any eye changes are due to Plaquenil or not. Ocular side effects appear to be dose related, so the risk increases with increased daily dosage. Individuals less than 5’3” to 5’7” in height regardless of weight should take less than 400mg of Plaquenil per day. Additionally, a person who weighs less than 135 pounds should take less than 400mg of Plaquenil per day according to current recommendations. Other factors that may increase the risk of ocular damage include age over 60 years, kidney disease, liver disease, and use of Tamoxifen.
| Plaquenil 200mg tablets | ||
| Recommended maximum dosage based on height and weight: | ||
| Weight (lbs): | Height: | Maximum dosage: |
| 68-77 | 4’0″ – 4’1″ | One table per day |
| 78-86 | 4’2″ – 4’3″ | One per day except Sunday take two a day |
| 87-96 | 4’4″ – 4’5″ | One per day except M-F take two a day |
| 97-106 | 4’6″ – 4’8″ | One per day except M-W-F two a day |
| 107-116 | 4’9″ – 4’10” | One per day except M-W-F-S two a day |
| 117-125 | 4’11” – 5’0″ | Two per day except weekend take one a day |
| 126-134 | 5’1″ – 5′ 2″ | Two per day except Sunday take one a day |
| ≥135 | 5’3″ or taller | Two per day |
*** See updated dosing schedule based on 2017 American Academy of Ophthalmology Guidelines.
What can you do to protect yourself?
Plaquenil is an effective medication with fewer side effects than other medicines used for the same purpose. However, it is important to monitor your eyes for side effects that might indicate the need to stop taking Plaquenil. The Amsler grid chart (below) should be checked at least once a week testing each eye separately, using glasses if needed. Look for a missing part of the grid either above or below the central dot while looking only at the center of the grid. Additionally, your Eye MD should examine your eyes every year with specific testing to look for early signs of retinal changes.
What happens if you develop retinal changes from Plaquenil?
Retinal damage from Plaquenil is extremely rare. If early retinal changes are found, Plaquenil may be discontinued. By discontinuing Plaquenil at an early stage, vision can be saved. Continued examination is important to monitor the eyes for further changes.
Reference: Article on early detection
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