Hydroxychloroquine dose and screening
Max daily dose by real weight, years on the drug, and when screening is due.
≤ 5.0 mg/kg/day real body weight, and under 400 mg/day for severely obese patients (AAO 2025 revision)
Baseline fundus exam, OCT and FAF soon after the drug starts. Then annual OCT and wide-pattern FAF, which may be deferred for the first 5 years without a risk factor (AAO 2025 revision).
About this calculator
The risk of hydroxychloroquine retinopathy rises with the daily dose for body weight and with the years on the drug. The 2025 revision of the AAO recommendations keeps the ceiling at 5.0 mg/kg/day of real body weight and keeps severely obese patients under 400 mg/day.
A baseline fundus exam with OCT and fundus autofluorescence belongs soon after the drug starts. Screening is then annual with OCT and wide-pattern autofluorescence. Annual exams may be deferred through the first 5 years when there is no risk factor, such as kidney disease, tamoxifen, an older age at the start, or a dose above 5.0 mg/kg/day.
Formula
Maximum daily dose = min(weight in kg × 5, 400) mg
Worked example
A 70 kg patient may take up to 350 mg/day. The same patient on 400 mg/day takes 5.7 mg/kg/day, which counts as a risk factor, so screening is annual from the start.
Sources
- AAO revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2025), Ophthalmology 2026;133:439–450