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!