HYDROXYCHLOROQUINE MONITORING PROTOCOL

Recommended Dosage.
6.5mg/kg lean body weight in the absence of renal or hepatic failure. Cumulative dose < 700g (i.e. 10 years @ 200mg/day or 5 years @ 400mg/day)

Monitoring Recommendations:

  1. Baseline assessment by Rheumatologist or Dermatologist
    • Establish renal and liver function
    • Check dosage <6.5mg/kg lean body weight and previous treatment
    • History of visual impairment (not corrected with glasses)
    • Record near vision (with reading glasses)
    If visual impairment present, review by optometrist or ophthalmologist.
  2. Annual review by Rheumatologist or Dermatologist
    • Check any visual symptoms
    • Record near vision
    • Refer to optometrist or ophthalmologist if visual impairment or change.
  3. Identify Early Maculopathies. Ophthalmic Review @ 5 yr.:
    • Check the drug and dosage (mg/kg and cumulative),
    • Visual Acuity,
    • Ishihara,
    • Fundus Examination,
    • Central Visual Field (Humphrey 10-2)
  4. Follow-up: Annual Review after 5yrs. (Note importance of cumulative dose).
    • Refer for Pattern ERG or multifocal ERG if tests abnormal or recommended dosage is exceeded.

Notes:

  1. Visual field defects occur before visual acuity or colour vision defects. Computerised visual field testing of the central 10 degrees is an objective technique for identifying Visual Field loss. Early defects tend to occur in superior field 3-8 degrees from fixation. Amsler charts are useful for self-screening but are subjective and variable.
  2. These guidelines recommend “at risk” patients on Hydroxychloroquine therapy for >5years are screened by an ophthalmologist. There have been no reported cases of toxicity within the recommended dosage.

References:

  1. Ocular Toxicity and Hydroxychloroquine: Guidelines for screening 2004 (Replacing The Royal College of Ophthalmologists Guidelines 1998) RCOpth. UK. www.rcophth.ac.uk/docs/publications/Oculartoxicity2004.pdf
  2. Recommendations on screening for Chloroquine and Hydroxychloroquine Retinopathy. American Academy of Ophthalmology. http://www.aao.org/education/library/statements/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=1228

Dr Dianne Sharp, FRACS FRANZCO
Medical Retinal Specialist.
August 2006



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