Chloroquine is now uncommonly used in favor of its derivative hydroxychloroquine. In the United States, hydroxychloroquine is most often used for its anti-inflammatory effects in rheumatology and dermatology. Plaquenil localized scleroderma Chloroquine and malaria Hydroxychloroquine plaquenil cancer Macular damage from hydroxychloroquine Figure 1 appears to be permanent and may continue to progress even after discontinuation of the drug due to its slow clearance from the body; in fact, the drug may persist in patients’ urine for years after discontinuation. 8-10 Therefore, detection of toxicity at its earliest stages is critical. Retinal toxicity is a very rare side effect of the hydroxychloroquine therapy, but when it has occurred, vision loss may be permanent and may progress even years after the cessation of medication. Patients would be examined every 3 months, then annually, until they are stabled. Lyons emphasizes the importance of annual screening and says that, although annual screening is recommended for everyone taking Plaquenil, it is imperative for people who have been taking the medication for more than 10 years, who have a higher incidence of retinal toxicity. Plaquenil-induced toxicity usually will not occur before five years of taking the drug. While early toxicity may be asymtomatic, patients with more advanced stage of toxicity may complain of color vision changes or paracentral scotomas. Its toxic effects on the retina are seen in the macula. Retinal toxicity from plaquenil years after discontinued Discontinued Plaquenil.other options?, Retinal toxicity associated with chronic exposure to. Can plaquenil be used in the treatment of multiple myeloma The incidence of HCQ retinopathy is very low. In fact, HCQ is estimated at having a 0.5% incidence of retinal toxicity after 5 years of therapy.5,6 Retinal toxicity secondary to HCQ is irreversible and can continue to progress following cessation of therapy. Prompt screening and serial monitoring, with the utilization of imaging modalities, is paramount importance to early detection. Hydroxychloroquine retinopathy A review of imaging. Protecting your eyesight when taking Plaquenil Lupus.. Retinal toxicity secondary to Plaquenil therapy - ScienceDirect. Several risk factors may increase the likelihood of retinal toxicity from Plaquenil such as, age of greater than 60 years, daily dose more than 6.5 mg/kg; use of the drug more than 5 years, obesity, preexisting retinal disease and, renal or liver failure. The drug remains in these parts even if the patients stopped taking the drugs. Studies have shown that patients who have manifested with retinopathy have traces of Plaquenil metabolites in their erythrocytes, plasma, and urine even after 5 years of discontinuing the medication 1, 2, 3. An example of advanced toxicity is presented here. A 68-year-old female with rheumatoid arthritis was treated with hydroxychloroquine 200 mg PO bid for almost five years. She complained of bilateral visual disturbances and discontinued the medication. She reported progressive symptoms for over one year following discontinuation.