In Sjögren’s, Plaquenil is used to treat many symptoms of Sjögren’s including fatigue, joint symptoms of arthritis and arthralgias (joint pain), dry mouth and dry eyes. Similar to its use in systemic lupus erythematosus, many clinicians feel that it is useful in reducing general Sjögren’s “disease activity.” One of the reasons that physicians feel comfortable in prescribing Plaquenil is its low risk to benefit ratio. Plaquenil and complement levels G6pd and hydroxychloroquine Chloroquine indication Of course the aim is avoid drug related retinal toxicity, which on ophthalmic examination, appears as the classic Bull’s eye change affecting the macula. Once retinal toxicity from hydroxychloroquine occurs, it is thought that the retinal changes are permanent and the disease can progress even if hydroxychloroquine is stopped for 1 to 3 years. Hui Jen Ding, Alastair K. Denniston, Vijay K. Rao, Caroline Gordon, Hydroxychloroquine-related retinal toxicity, Rheumatology, Volume 55, Issue 6, June 2016, Pages 957–967. High-speed ultra-high-resolution optical coherence tomography findings in hydroxychloroquine retinopathy. These findings prompted the question of possible early hydroxychloroquine retinopathy. Fluorescein angiogram of left macula in patient with hydroxychloroquine retinopathy. Reprinted from American Journal of Ophthalmology, Vol 104, Johnson and Vine, Hydroxychloroquine therapy in massive total doses without retinal toxicity, pages 139-144. As with any medication, allergic reactions including skin rashes and non-allergic reactions can occur. This means that the side effects of Plaquenil are mild and infrequent compared with its potential benefits. Oct findings in plaquenil toxicity Bull's-eye maculopathy due to hydroxychloroquine toxicity, Hydroxychloroquine-related retinal toxicity Rheumatology. Chloroquine phosphate malariaHydroxychloroquine vision side effectsDoes plaquenil help with scarring alopecia In early toxicity there are no visible signs, but field, OCT and mfERG changes can be detected. If abnormalities are present only unilaterally, investigate other causes besides hydroxychloroquine toxicity see “Differential Diagnosis of Bull’s-Eye Maculopathy”. Hydroxychloroquine-Induced Retinal Toxicity - American.. Chloroquine and Hydroxychloroquine Toxicity Clinical.. Optical coherence tomography based microangiography.. Dosage levels that can cause toxicity 6.5 mg/kg Hydroxychloroquine Plaquenil19 3 mg/kg Chloroquine Arlen With Plaquenil Plaquenil is manufactured in only a 200 mg tablet The typical dosage is either 200 or 400 mg per day 200 mg daily puts anyone under 68 pounds at risk1 However, variable SD-OCT findings related to Plaquenil retinal toxicity can make the screening data challenging to interpret; thus, it is important that clinicians become familiar with the spectrum of SD-OCT findings. In obvious toxicity, the nasal inner subfield showed more thinning than the temporal inner subfield at 12 months after drug cessation p = 0.018, 95 % CI −1 to −8 μm. Conclusions Once HCQ retinopathy is diagnosed and the medication is discontinued, structural retinal changes commonly occur.