From the Research
Hydroxychloroquine (Plaquenil) dosing for dialysis patients typically does not require adjustment as the drug is primarily metabolized by the liver and only minimally removed by dialysis. The standard dosing of 200-400 mg daily can generally be maintained for dialysis patients. However, since hydroxychloroquine can accumulate in tissues over time, some clinicians recommend monitoring for toxicity more closely in patients with end-stage renal disease 1.
Key Considerations
- For patients on hemodialysis or peritoneal dialysis, the medication should be administered after the dialysis session on dialysis days to prevent any potential minimal removal during the procedure.
- Patients with renal impairment should be monitored regularly for adverse effects, particularly retinal toxicity, with baseline and periodic ophthalmologic examinations recommended 2.
- Hydroxychloroquine has a very long half-life (approximately 40-50 days), which contributes to its sustained tissue levels and allows for consistent therapeutic effects even if occasional doses are missed due to dialysis scheduling.
- If signs of toxicity develop, dose reduction or discontinuation may be necessary, with close clinical monitoring.
Dosing Recommendations
- The daily dose of hydroxychloroquine should not exceed 5 mg/kg to minimize the risk of retinal toxicity 1.
- Regular screening for retinal toxicity is essential, especially in patients with risk factors such as longer duration of hydroxychloroquine use, higher daily dose, and presence of kidney disease 1.