Hydroxychloroquine

Abstract

The only antimalarial drug approved by the Food and Drug Administration for the treatment of lupus erythematosus is hydroxychloroquine (Plaquenil®) sulfate. The dosage recommended officially for this disease is vague. Retinopathy has been caused by hydroxychloroquine but not in less than six months, nor when a total dosage of less than 72 gm or a daily dose of 200 mg or less is used. The ocular risk depends on the dose/weight ratio and is almost negligible at a dosage of less than 6 mg/kg/day. At a dosage of 400 mg or more daily, the risk/benefit ratio is acceptable for a person of average weight, provided that ophthalmologic monitoring is adequate. Risk of retinal toxicity is then proportional to duration of therapy and consequent cumulative dose. Ophthalmoscopic examinations at six-month intervals should be sufficient to detect occasional adverse reactions. Such tests could be conducted by the attending physician directly, as long as no pre-existing ocular abnormality exists.