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Jing Grace Wang, Jonathan Levine; Avoiding the Bull’s Eye: Ensuring “On-Target” Hydroxychloroquine Dosing and Eye Screening in an Inner-City Hospital . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1793.
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The American Academy of Ophthalmology (AAO) recommendations that were subsequently endorsed by the American College of Rheumatology established the guidelines with respect to the monitoring of ocular toxicity from Hydroxychloroquine (HCQ, Plaquenil®). Our hospital’s adherence rate to the official guidelines is not known. We performed a retrospective chart review to assess the HCQ dosing in our outpatient service and to compare the dosing to the AAO guidelines.
We identified all patients who had been prescribed HCQ between 12/1/2008 and 5/22/2014 in an inner-city hospital. Daily doses of each patient were collected based on log of all HCQ prescription. Maximal safe daily dose of each patient is calculated based on 6.5 mg/kg of ideal body weight. Actual daily dose was then compared to the maximal safe daily dose to determine the safe dosing.
643 patients have been prescribed HCQ between 12/1/2008 and 5/22/2014 at BLHC outpatient. 86% of them are female, 62% are Hispanic, and the average age is 52 (range 19-91). Daily dosage of HCQ was 400 mg in 496/575 (86%) patients. 402/575 (70%) had daily dosages of HCQ above the recommended 6.5 mg/kg of ideal body weight.
The daily dose of HCQ for most (70%) patients exceeded the AAO safety guidelines. More effective communication may be required between the Department of Ophthalmology and prescribing physicians regarding retinopathy status and detection of potentially toxic dosing. However, the dosing decision for each patient ultimately depends on the judgment of the prescribing physician, and requires weighing all the risks and benefits of different dosing levels.
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