Hydroxychloroquine toxicity and aromatase inhibitors

Abstract

Hydroxychloroquine (HCQ) is a widely used treatment for many dermatologic conditions and is generally well tolerated. Retinal toxicity is a recognised side effect and is dependent on daily dose and duration of use.¹ Guidelines from the Royal College of Ophthalmologists (2009) recommend a maximum daily dose of 6.5mg/kg lean body weight.² Recent guidelines (2016) from the American Academy of Ophthalmology (AAO) recommend a maximum daily dose of 5mg/kg real body weight.¹ Baseline fundus examination is recommended to rule out pre-existing maculopathy, followed by annual screening from 5 years, in patients without major risk factors e.g. high daily dose, renal disease, pre-existing retinal or macular disease.¹ A 2014 retrospective case-control study of 2361 patients on HCQ for the previous 5 years identified concomitant tamoxifen therapy as an additional major risk factor for developing retinal toxicity (odds ratio 4.59).³

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