Hydroxychloroquine retinopathy is dose- and duration-dependent and irreversible once established. The daily dose should not exceed 5 mg per kg of actual body weight, which for a 50 kg woman is 250 mg — less than the common 400 mg default. Risk rises with renal impairment and tamoxifen use. Screening with OCT and automated visual fields catches damage before the patient notices it.
- Calculate the dose as ≤5 mg/kg actual body weight per day; use alternate-day dosing to reach it with 200 mg tablets.
- Arrange a baseline eye examination within the first year of treatment.
- Start annual OCT and visual field screening after five years, or earlier with renal impairment or tamoxifen; in Asian patients, extend testing beyond the central macula (24-2 or 30-2 visual fields and wide-field OCT).
- Reduce the dose if eGFR falls.
- Do not stop hydroxychloroquine in lupus without good reason; it reduces flares and improves survival.
Why it matters
The default 400 mg dose exceeds the safe limit for many lighter Indian patients.
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