[6] HCQ retinopathy is not reversible and cellular damage may progress for a number of years even after the drug is stopped. Therefore, it is essential to continue following the patient appropriately.
In general, hydroxychloroquine and chloroquine retinopathy are not reversible, and even following drug cessation, cellular damage appears to continue for a certain period of time. However, the earlier the retinopathy is recognized, the greater the chance of visual preservation.
Effects on the eye
The most important side effect of hydroxychloroquine is on the eye. Blurred vision may occur in the first few weeks after starting hydroxychloroquine. This usually returns to normal even when you continue taking the tablets.
Retinopathy is the major concern: others are more common but benign. The incidence of true hydroxychloroquine retinopathy is exceedingly low; less than 50 cases have been reported.
“If you feel like your central vision is getting blurred, if you lose the ability to see a digital clock, if you lose color vision—if reds look kind of washed out—or if you have trouble seeing at night: Those are early signs that you might be developing Plaquenil retinopathy,” says Katz.
Plaquenil stays in your body for about 3 months. If you must stop it, it will take a while for the side effects to go away. You should have an eye examination every year to prevent a very rare but serious eye problem.
Hydroxychloroquine retinal toxicity is far more common than previously considered; an overall prevalence of 7.5% was identified in patients taking HCQ for greater than 5 years, rising to almost 20% after 20 years of treatment.
Hydroxychloroquine is generally safe at normal doses, but higher amounts can damage the retina, the light-sensitive tissue at the back of the eye, and could result in partial or complete blindness.
Ocular symptoms of retinopathy associated with these medications can include blurred vision, partial loss of central and peripheral vision and in the later stage, loss of night vision. Symptoms of corneal deposits include haloes and glare.
Patients starting treatment with Plaquenil should have a baseline eye examination within the first year of taking this medication and then regular screenings thereafter; every six months or yearly as advised by your eye doctor.
Stopping Plaquenil
Plaquenil stays in the body for around three months and it may take a while for side effects to go away. There is no official data regarding hydroxychloroquine or Plaquenil withdrawal symptoms. But some studies have shown that people may have disease flare-ups after stopping treatment.
Like all medicines, hydroxychloroquine can cause side effects, although not everyone gets them. Side effects are more likely when you first start taking it or when your dose is increased. You'll usually feel better after a week or two.
Following cumulative doses of 1000 g, the prevalence of retinal toxicity increases to 1% and is associated with an irreversible loss of vision despite cessation of the drug [82]. In some cases, progression of vision loss is present for up to one year after discontinuation of the offending agent.
You can reduce your risk of developing diabetic retinopathy, or help stop it getting worse, by keeping your blood sugar levels, blood pressure and cholesterol levels under control. This can often be done by making healthy lifestyle choices, although some people will also need to take medication.
How long you take hydroxychloroquine for depends on why you're taking it. For some conditions, if hydroxychloroquine works for you then you may need to take it for several years, or even for the rest of your life, to control your symptoms.
Damage caused by diabetic retinopathy is typically permanent. This condition isn't fully reversible, but some treatments may help bring some of your vision back. While treatments aren't likely to return your vision, your eye doctor can help prevent your vision from worsening.
There is no single best test for detecting hydroxychloroquine toxicity. However, SD-OCT and VF are good screening tests, and FAF and mfERG can help confirm a diagnosis of suspected retinal toxicity from hydroxychloroquine. Early detection of toxicity is critical to prevent permanent visual loss.
The guidelines recommend that all patients planning to take hydroxychloroquine long term i.e. over five years have a baseline examination in a hospital eye department ideally within six months, but definitely within 12 months, of starting therapy with a colour retinal photograph and spectral domain optical coherence ...
Hydroxychloroquine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.
Adults—At first, 400 to 600 milligrams (mg) taken as a single dose or in two divided doses per day. Then, 200 mg once a day or 400 mg taken as a single dose or in two divided doses per day. Your doctor may adjust your dose if needed. Children—Use and dose must be determined by your doctor.
We found that 7.5% of long-term hydroxychloroquine users screened with modern techniques showed evidence of retinal toxicity.
Currently, one of the primary functional screening tests recommended for the evaluation of Plaquenil retinal toxicity is 10-2 white stimulus automated visual fields; however, research shows Asian patients benefited from 24-2 or 30-2 visual fields, given that toxicity often manifests changes beyond the macula in these ...
Cautions with other medicines
If you take antacids, leave a gap of at least 4 hours between taking them and hydroxychloroquine. Tell your doctor or pharmacist if you're taking any other medicines, including: azithromycin, erythromycin or clarithromycin, antibiotics. amiodarone or digoxin, medicines for heart problems.
Plaquenil and other anti-malarials are the key to controlling lupus long term, and some lupus patients may be on Plaquenil for the rest of their lives.
Hydroxychloroquine may potentially result in adverse effects on the central nervous system, mainly irritability, nervousness, emotional changes, nightmares, and even true psychoses [3, 4].