Despite the 2016 recommendation change by the AAO with regards to screening for chloroquine and hydroxychloroquine (HCQ), physicians should consider maximum HCQ dose on ideal weight for patients who are short and obese and real weight for short, thin individuals, according to David J. Browning, MD, PhD, a retinal specialist with Charlotte Eye Ear Nose and Throat Associates in North Carolina.
In making the change, guideline authors noted that patients taking doses >5.0 mg/kg of real body weight per day were at greater risk of developing toxicity. “Real weight correlates better with risk compared with ideal weight,” they stated.
However, said Dr. Browning, the change presented a “paradoxical situation in which the guidelines encourage the real weight method using a new threshold of 5 mg/kg, but the data show that dose increases the risk of toxicity in patients who are obese.”
Dr. Browning and colleagues attempted to replicate the findings on which the AAO based its recommendations. They were able to for the ideal body weight method that was used, but not the real body weight method. For that reason, he concluded that “dosing HCQ by ideal body weight is unsafe for short asthenic somatotypes, and dosing by real body weight is unsafe for short obese somatotypes.” He suggested that using the lower dose between ideal and real body weight is the safest approach of all.
Koury Conni. Safe dosing for HCQ dependent on body type. [Published online May 9, 2018]. Modern Retina. http://modernretina.com/article/safe-dosing-hcq-dependent-body-type
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