Hydroxychloroquine is recommended for nearly every patient with systemic lupus erythematosus unless there is a contraindication. It lowers flare rates, protects against organ damage and thrombosis, and improves survival, so stopping it when the disease is quiet is a common and avoidable cause of flare.
Keep the dose at or below 5 mg/kg actual body weight a day to limit retinal toxicity. Arrange a baseline eye examination and annual screening from five years of use, or sooner with kidney impairment, tamoxifen or pre-existing maculopathy, using visual fields and OCT. Reduce the dose in significant kidney impairment, and check adherence if lupus flares unexpectedly.
- Continue hydroxychloroquine in quiescent lupus unless there is a clear reason to stop.
- Keep the daily dose at or below 5 mg/kg actual body weight.
- Arrange baseline retinal examination and annual screening after five years.
- Screen sooner with kidney impairment or tamoxifen use.
- Ask about adherence when lupus flares unexpectedly.
Why it matters
Stopping hydroxychloroquine in stable lupus invites flares, and dosing by weight protects the retina.
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