In the initial stages of hydroxycloroquine toxicity, patients are often asymptomatic. If they do have symptoms they complain of visual color deficits, specifically red objects, missing central vision, difficulty reading, reduced or blurred vision, glare, flashing lights, and metamorphopsia.
“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.
Data synthesis: Hydroxychloroquine ocular toxicity includes keratopathy, ciliary body involvement, lens opacities, and retinopathy. 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.
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.
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. Talk to your doctor if you are worried.
Plaquenil binds to retinal pigment cells, causing adverse changes in vision that occur slowly over time. Objects may start to appear blurry or distorted. In the most serious cases of Plaquenil-induced retinal toxicity, the macula is completely destroyed.
Nausea, vomiting, and diarrhea are the most common side effects of hydroxychloroquine. And some people may also experience stomach pain.
Unfortunately, vision loss from Plaquenil is not reversible.
This will help you avoid permanent vision loss. Your other doctor will find another treatment for your disease.
Dosage and strength
The usual dose for adults is 200mg to 400mg each day. If your child is prescribed hydroxychloroquine, their doctor will work out their dose based on their height and weight.
Retinal toxicity is most frequently characterized by symptoms of central visual loss including reading difficulties, reduced color vision, and central scotomata. Maculopathy ranging from a subtle disturbance of the retinal pigment epithelium to bull's-eye maculopathy has been described.
Long-term use and high doses of hydroxychloroquine are risk factors for the development of cardiomyopathy. Cardiac failure, conduction disorders (including QT prolongation and Torsades de Pointes) and sudden cardiac death are consequences of the cardiomyopathy.
Its most frequent use now is for rheumatoid arthritis (RA) and Lupus and is often very effective in mitigating the joint and arthritic symptoms these diseases can cause. One of the most significant side effects of the drug is its possibility of causing eye problems resulting in blurred or decreased vision.
How often do I need eye exams? You will have exams when you start taking the medicine, and every year if you at higher risk for eye disease. We will remind you that your yearly eye exams are needed when you are at clinic visit, or when you contact us to refill your medicine.
When you visit an ophthalmologist for a Plaquenil eye exam, your doctor will perform different tests to detect the presence or extent of retinal damage due to this medication. A Plaquenil screening may include a visual field test, OCT imaging, multifocal ERG, and photos of your eye.
Interactions between your drugs
No interactions were found between hydroxychloroquine and Vitamins.
The study found that a person who decreases her/his HCQ dose is 54% more likely to experience a flare sooner than someone who maintains the same dose. And, if someone stops taking the medication entirely, she/he is 61% more likely to have a flare sooner than someone who continues on HCQ.
Hydroxychloroquine acts by suppressing Toll-like receptors to trigger important immunomodulatory effects. Hydroxychloroquine is a well-established and effective therapy for systemic and cutaneous lupus and other autoimmune diseases.
Hydroxychloroquine (Plaquenil) is the most common antimalarial for lupus. If you can't take hydroxychloroquine, your doctor may recommend chloroquine (Aralen®). These medicines can be taken as pills or liquids.
If your symptoms don't improve, your doctor will likely recommend discontinuing the medication. However, if you and your doctor determine that the medicine is working for you, you should continue taking it as prescribed. If you stop using Plaquenil, your symptoms will reappear.
Using Plaquenil for a long period of time may harm the retina, causing serious vision loss. People with retinal damage from Plaquenil are not aware at first that they are losing vision.
Hydroxychloroquine may potentially result in adverse effects on the central nervous system, mainly irritability, nervousness, emotional changes, nightmares, and even true psychoses [3, 4].
Hydroxychloroquine (brand name Plaquenil) side effects range from more common, mild issues such as headache, nausea and stomach pain to serious but rare conditions such as heart problems, muscle weakness and convulsions.