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Thread: Plaquenil for Short People (Newer Dosing Guidelines from Ophthalmologists)

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    Default Plaquenil for Short People (Newer Dosing Guidelines from Ophthalmologists)

    So, I got my first Plaquenil eye exam today, and the first thing the ophthalmologist asked me was, "How tall are you and how much Plaquenil do you take?" I told her "Five foot four, and 400 mg per day." She nodded and said, "You're taking too much."

    She went on to explain to me that 400 mg per day has been the standard Plaquenil (hydroxychloroquine) dose for ages, based on the guideline of 6.5mg/kg/day being a safe dose. However, because Plaquenil is not absorbed into fatty tissue, she said, the weight used for determining a safe dose should be our "dry" weight-- that is, how much we would weigh without fat. So, she said, recently Ophthalmologists have recommended that dosing be based on height. For people 5'6" and taller, 400mg is a safe dose. But for us shorter folk, regardless of how much we actually weigh, we need to be on a lesser dose. She told me I should start taking 300 mg per day instead of 400 mg because 400 mg is "too much for a little person" like me, and staying on the higher dose would increase my risk of Plaquenil toxicity and eye damage.

    I have a call in to my rheumatologist to confirm lowering the dose is okay with him, but I wanted to share this information with everyone because apparently these new dosing guidelines have been slow to be adopted by rheumatologists because they're so used to prescribing 400 mg per day. I've done some research online, and I found a good article from the American Academy of Ophthalmology that discusses the new dosing guidelines, which is available at http://www.aao.org/publications/eyen...p-May-2011.pdf.

    So, if you're a shorty (under 5'6"!) on Plaquenil, and you're taking more than 300mg/day, I'd recommend you talk to your rheumatologist about lowering your dose to a level more appropriate for your size. Though Plaquenil toxicity is rare, it would really suck to go partially blind years down the line!
    Last edited by Derrie; 06-13-2012 at 05:34 PM.

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    Quote Originally Posted by Derrie View Post
    So, I got my first Plaquenil eye exam today, and the first thing the ophthalmologist asked me was, "How tall are you and how much Plaquenil do you take?" I told her "Five foot four, and 400 mg per day." She nodded and said, "You're taking too much."

    She went on to explain to me that 400 mg per day has been the standard Plaquenil (hydroxychloroquine) dose for ages, based on the guideline of 6.5mg/kg/day being a safe dose. However, because Plaquenil is not absorbed into fatty tissue, she said, the weight used for determining a safe dose should be our "dry" weight-- that is, how much we would weigh without fat. So, she said, recently Ophthalmologists have recommended that dosing be based on height. For people 5'6" and taller, 400mg is a safe dose. But for us shorter folk, regardless of how much we actually weigh, we need to be on a lesser dose. She told me I should start taking 300 mg per day instead of 400 mg because 400 mg is "too much for a little person" like me, and staying on the higher dose would increse my risk of Plaquenil toxicity and eye damage.

    I have a call in to my rheumatologist to confirm lowering the dose is okay with him, but I wanted to share this information with everyone because apparently these new dosing guidelines have been slow to be adopted by rheumatologists because they're so used to prescribing 400 mg per day. I've done some research online, and I found a good article from the American Academy of Ophthalmology that discusses the new dosing guidelines, which is available at http://www.aao.org/publications/eyen...p-May-2011.pdf.

    So, if you're a shorty (under 5'6"!) on Plaquenil, and you're taking more than 300mg/day, I'd recommend you talk to your rheumatologist about lowering your dose to a level more appropriate for your size. Though Plaquenil toxicity is rare, it would really suck to go partially blind years down the line!
    Ugghhh my doctor tells me nothing, i'm barely 5 foot and have recently found out the plaquenil is starting to mess with my eyes.

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    If thats the case Im screwed too, I'm 4'10 lol, and I've noticed my vision is becoming worse, blurry and I can barely see at night, i've put off and eye test because it's not covered until next year, and I've got contacts and glasses to last me until then, man this sucks!
    Diagnosed in 2010 with SLE, recurring pericarditis, pericardial and pleural effusions. Fibromyalgia, Avascular Necrosis on both knees, IBS, Gastroparesis, migraines, DVT's, Pulmoray Emboli. Arthritis, pinched nerves and bulging disk all on the neck. Hyperthyroid issues. Neuropthy, anemia and insomnia "taking it one day at a time, what more can I do"

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    So, my rheumatologist's office called back and confirmed I should lower my dose. I'm now supposed to take 300 mg per day, 200 mg in the morning and 100 mg in the evening. I'll just have to cut one of my 200 mg pills in half for the evening dose.

    Mica and Linda, I really encourage both of you to print off that article I posted and share it with your doctors. The problem seems to be that the new dosing guidelines were developed by Ophthalmologists (who are the experts when it comes to Plaquenil toxicity), and the information hasn't completely made its way across the specialty divide to all the rheumatologists. By sharing this information with your doctors, you could actually be doing other patients in their practices a favor if they shift their dosing guidelines for most people!

    From what I can tell, Plaquenil toxicity is still quite rare (even for short folk), but our risk is further reduced by taking the appropriate doses.

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    Interesting stuff. It makes sense. I wonder how they figure out your "dry weight".

    I'm 6' 1" tall and 200lbs, and my body fat percentage is 14%.

    I take 400mg plaq per day. 200mg in the morning, and 200mg at night.

    I wonder if there's formula to figure out the recommended dosage according to these newly revised standards.

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    I wonder how they'd figure it out with me...I stand 5 foot 3 and I have pretty much zero body fat lol...Well unless you count my butt. The most Plaque I am gonna take is 200mgs because that's all my stomach can handle.
    "With gentle hands and the heart of a fighter, I am a survivor!" - Reba McEntire

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    Great info! Thanks for sharing!
    Mari

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    Quote Originally Posted by rob View Post
    Interesting stuff. It makes sense. I wonder how they figure out your "dry weight".

    I'm 6' 1" tall and 200lbs, and my body fat percentage is 14%.

    I take 400mg plaq per day. 200mg in the morning, and 200mg at night.

    I wonder if there's formula to figure out the recommended dosage according to these newly revised standards.

    It sounds, like you are a hunk.

    Debbie
    I may have been dealt a bad hand, but at least I'm still playing with a full deck. ( most of the time anyway).

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    Quote Originally Posted by rob View Post
    Interesting stuff. It makes sense. I wonder how they figure out your "dry weight".
    Sounds like you're fine on the dosing, Rob.

    So, my understanding of how this works is the "dry weight" is standard for everyone. It's the "lean" weight based on your height. For women, that weight is 100 lb at 5'0" and you add 5 pounds for each inch in height. So, every female who is 5'4" has a "dry weight" of 120 pounds.

    For men, the dry weight is 110 lb at 5'0", and add 5 pounds for each inch. So, Rob, you're 13 inches taller than 5'0", so your dry weight would be 110 + 65, or 175 lb.

    So, you take whatever dry weight is appropriate for your sex and height, and then apply the 6.5mg/kg/day standard. To satisfy my inner math geek, I'll do Rob's calculation here:

    At 6'1" and male, Rob's "dry weight" is 175 lb. Converted to kilograms (1 lb = .454 kg), Rob's dry weight is approximately 75 kg. At a safe dose of 6.5mg/kg/day (6.5 X 75), Rob can take up to 487.5mg of Plaquenil per day without significantly increasing his risk of toxicity and eye damage.

    Using the same calculation (dry weight x .454 x 6.5), my highest safe dose, as a 5'4" female, would be 354mg of Plaquenil per day.

    Well, my inner math geek is satisfied. Make sense to you all? Our real weights don't matter in this calculation; just our sex and height.

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    Derrie,
    My ophthalmologist mentioned this when I saw him in February. You are right - they are the real experts about this.
    Like Hunniebun, my tummy can't handle more than one 200 mg. pill per day, so he's pleased that I'm on that dose.
    I tried to bring it up at my rheumy appointment yesterday, but she wasn't interested and didn't take time to discuss it.
    Man, I'm thankful for my ophthalmologist.
    BTW - I agree - Rob sounds like the hunk of WHL. Karen is a lucky lady and she should hang on to him!
    Hugs,
    Marla
    Last edited by magistramarla; 06-14-2012 at 09:06 PM.

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