Retinal toxicity is a side effect of hydroxycholoquine and can lead to irreversible vision loss. The incidence of retinal toxicity is related to dose and duration of treatment. The American Academy of Ophthalmology (AAO) published guidelines on safe dosing in 2016 and recommended a maximum daily dose of ++<++5mg/kg.¹ An analysis of all patients seen at Cleveland Clinic from 1/1/2018 to 12/21/2018 was performed. The prevalence of excess weight-based dosing among rheumatologists was 27% (29% in women and 18% in men). Dermatologists were more likely to dose excessively compared with rheumatologists (OR 1.93, CI1.23-3.03).
An Epic alert was created (in collaboration with the Cole Eye Institute) for any placed order exceeding the dosing guidelines. Captured data includes patient, department/hospital, prescriber, override reason, ordered dose, and percentage over the max dose. Data analysis is planned at 6 months to assess change in excessive dosing.