Pilot
This is a new service – your feedback will help us to improve it.
Using this page · Individualise medicines monitoring

This medicines monitoring page has been written using publications and expert opinion. It is designed to save clinician time, but not replace professional responsibility. When using this page you should: ensure an individualised monitoring plan is developed in partnership with the patient and take account of any locally agreed advice and guidance.

Before starting

Required

  • Baseline
    • Albumin
    • ALT or AST
    • Blood pressure
    • Full blood count
    • Height
    • Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
    • Weight
    • Vaccination status

Vaccination status

Consider vaccination against pneumococcus and influenza prior to starting treatment.

Consider in patients at risk of infection

  • Baseline
    • Hepatitis B
    • Hepatitis C
    • HIV

Consider

  • Baseline
    • Lung disease screening

Ongoing once stable

Required

  • Annually if increased risk; otherwise once after 5 years and then annually
    • Ophthalmological examination

Patients requiring monitoring

It is the prescriber’s responsibility to refer patients for monitoring.

Patients with additional risk factors may require annual retinopathy monitoring; risk factors include:

  • very high dose of drug therapy (hydroxychloroquine dose over 5mg per kg per day- based on actual body weight)
  • concomitant tamoxifen therapy
  • renal insufficiency (eGFR less than 60ml/min/1.73m2)

Responding to ophthalmological examination

Ophthalmologists should communicate the results of retinal monitoring to the prescribing doctor, patient and GP telling them whether the results are normal, possible or definite hydroxychloroquine retinopathy.

Prescribers should act on the results of monitoring.

Patients who are drivers with definite toxicity should be advised not to drive until reviewed by an ophthalmologist. The patient should inform the Driver and Vehicle Licensing Agency (DVLA).

Consider

  • Periodically
    • Albumin
    • ALT or AST
    • Estimated glomerular filtration rate
    • Skeletal muscle functionstop drug if weakness occurs
    • Tendon reflexesstop drug if weakness occurs
    • Weight

Responding to renal and liver impairment

Adjust dose and consider increasing screening frequency.

Notes

Baseline ophthalmological examination

Before starting hydroxychloroquine, ophthalmological examination is not currently recommended.

Bibliography

Enquiries about this page

Contact us if you have any enquiries about the drug monitoring information on this page.