Generic Name: Primaquine Brand Name(s): Generics only. No brands available.

Uses

What is Primaquine used for?

Primaquine is used with other medications to prevent and treat malaria caused by mosquito bites in countries where malaria is common. Malaria parasites can enter the body through these mosquito bites, and then live in body tissues such as red blood cells or the liver. Primaquine is used after other medications (such as chloroquine) have killed the malaria parasites living inside red blood cells. Primaquine then kills the malaria parasites living in other body tissues. This prevents the return of the infection. Both drugs are needed for a complete cure. Primaquine phosphate belongs to a class of drugs known as antimalarials.

How should I take Primaquine?

Take this medication by mouth, usually once daily with food to prevent stomach upset, or as directed by your doctor. Follow your doctor’s directions exactly. Primaquine is usually taken for 2 weeks after you have left the malarious area. It is started during the last 1-2 weeks of your other malaria treatment or immediately after you have finished your other treatment. Primaquine should not be taken for more than 14 days for malaria treatment.

Dosage is based on the kind of infection you have and your response to treatment. Take this medication regularly. To help you remember, take it at the same time every day.

It is very important to continue taking this medication exactly as prescribed by your doctor. Do not take more or less of this drug than prescribed. Do not stop taking it before completing treatment, even if you feel better, unless directed to do so by your doctor. Skipping or changing your dose without approval from your doctor may cause prevention/treatment to be ineffective, cause the amount of parasite to increase, make the infection more difficult to treat (resistant), or worsen side effects.

It is important to prevent mosquito bites (such as by using appropriate insect repellents, wearing clothes that cover most of the body, remaining in air-conditioned or well-screened areas, using mosquito nets, using insect-killing spray). Buy insect repellent before traveling. The most effective insect repellents contain diethyltoluamide (DEET). Ask your doctor or pharmacist to recommend the appropriate strengths of mosquito repellent for you/your children.

No drug treatment is completely effective in preventing malaria. Therefore, seek immediate medical attention if you develop symptoms of malaria (such as fever, chills, headache, other flu-like symptoms), especially while in the malarious area and even after completing this prescription. Quick treatment of malaria infection is needed to prevent serious, possibly fatal, outcomes.

When using primaquine phosphate for treatment of infection, tell your doctor if your condition persists or worsens.

How do I store Primaquine?

Primaquine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Primaquine in the bathroom or the freezer. There may be different brands of Primaquine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Primaquine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Primaquine?

Before taking primaquine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: immune system disease (such as lupus, rheumatoid arthritis), blood problems (such as low white blood cell counts, anemia), history of blood problems due to primaquine (such as hemolytic anemia, methemoglobinemia), personal/family history of favism, low levels of certain blood enzymes (glucose-6-phosphate dehydrogenase-G6PD, NADH methemoglobin reductase).

Your doctor may order a blood test to see if you have any enzyme deficiency before starting primaquine.

This drug may make you dizzy. Alcohol or marijuana can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

Primaquine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.

The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using primaquine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/”water pills”) or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using primaquine safely.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

 

Older adults may be more sensitive to the side effects of this drug, especially QT prolongation (see above).

This medication must not be used during pregnancy. It may harm an unborn baby. Women of child-bearing age should have a pregnancy test before starting this medication. It is important to prevent pregnancy during and after treatment with primaquine. Men and women must use reliable forms of birth control (such as condoms, birth control pills) during treatment. Men should continue to use birth control for at least 3 months after the end of treatment. Women should continue to use birth control for at least 1 menstrual cycle after the end of treatment. If you become pregnant or think you may be pregnant, tell your doctor right away. While you are pregnant, traveling to an area with malaria puts you and your infant at a much higher risk for death and other problems. The CDC recommends continuing your other malaria treatment (such as chloroquine) throughout pregnancy until delivery to prevent harm to your unborn baby (hemolytic anemia). After delivery, you may finish treatment with primaquine. Discuss the risks and benefits with your doctor.

It is not known whether this drug passes into breast milk and the effect on a nursing infant is unknown. The doctor should test your infant for G6PD deficiency before breastfeeding. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Primaquine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Primaquine. Primaquine is pregnancy risk category N according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Primaquine?

Nausea, vomiting, dizziness, stomach upset, and abdominal cramps may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if any of these rare but very serious side effects occur: signs of serious infection (such as high fever, severe chills, persistent sore throat), signs of a sudden loss of red blood cells (such as severe tiredness, brown urine, pale lips/nails/skin, fast heartbeat/breathing with usual activities), signs of a certain blood problem (methemoglobinemia, including bluish skin/lips/nails, headache, shortness of breath, lightheadedness, weakness, confusion, chest pain, sudden pounding heartbeat).

Get medical help right away if any of these rare but seriousfast/irregular heartbeat, severe dizziness, fainting.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Primaquine?

Some products that may interact with this drug include: penicillamine, quinacrine, drugs that may cause decreased blood cells (such as trimethoprim, zidovudine, pyrimethamine, azathioprine).

Primaquine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Primaquine?

Primaquine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Primaquine?

Primaquine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Primaquine.

What is the dose of Primaquine for an adult?

Usual Adult Dose for Malaria

Manufacturer Recommendations: 15 mg base (26.3 mg salt) orally once a day for 14 days

Comments:

-Recommended only for the radical cure of vivax malaria, the prevention of relapse in vivax malaria, or after the end of chloroquine phosphate suppressive therapy in vivax malaria-endemic area

-Should be given with chloroquine phosphate (destroys erythrocytic parasites and stops attack) to destroy exoerythrocytic parasites

Use: For the radical cure (prevention of relapse) of malaria due to Plasmodium vivax

US CDC Recommendations: 30 mg base (52.6 mg salt) orally once a day for 14 days

-Alternate regimen: 45 mg base (78.9 mg salt) orally once a week for 8 weeks

Comments:

-For the radical cure of malaria due to P vivax or P ovale

-Since this drug usually is not active against asexual erythrocytic forms of plasmodia, it should be administered with other appropriate antimalarial agents.

-This drug eradicates any hypnozoites that may be dormant in the liver and, thus, prevent relapses.

-The alternate regimen is recommended for patients with borderline glucose-6-phosphate dehydrogenase (G6PD) deficiency or as an alternative to the daily regimen.

-If the alternate regimen is considered for use in those with borderline G6PD deficiency, consultation with an infectious disease and/or tropical medicine expert is recommended.

-This drug is not recommended for use during pregnancy but should be used after delivery in patients without G6PD deficiency.

Usual Adult Dose for Malaria Prophylaxis

Manufacturer Recommendations: 15 mg base (26.3 mg salt) orally once a day for 14 days

Comments: Recommended only for the radical cure of vivax malaria, the prevention of relapse in vivax malaria, or after the end of chloroquine phosphate suppressive therapy in vivax malaria-endemic area

Use: For the radical cure (prevention of relapse) of malaria due to P vivax

US CDC Recommendations: 30 mg base (52.6 mg salt) orally once a day

Comments:

When used for primary prophylaxis:

-Should be taken 1 to 2 days before travel to malarious areas, while in such areas, and for 7 days after leaving the areas

-Generally used for short-duration travel to areas with primarily P vivax.

When used for terminal prophylaxis (presumptive antirelapse therapy):

-To reduce risk for relapses of malaria due to P vivax or P ovale; indicated for patients with prolonged exposure to P vivax, P ovale, or both

-This drug should be taken for 14 days after the patient has left the malarious area.

-When chloroquine, doxycycline, or mefloquine is used for primary prophylaxis, this drug should be used during the last 2 weeks of postexposure prophylaxis.

-When atovaquone-proguanil is used for prophylaxis, this drug may be used during the last week of atovaquone-proguanil plus an additional 7 days.

-Concurrent use of this drug with the primary prophylaxis agent is preferred; if not possible, this drug should still be used after the primary prophylactic agent has been finished.

Usual Adult Dose for Pneumocystis Pneumonia

US CDC, National Institutes of Health (NIH), and HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/IDSA) Recommendations for HIV-infected Patients: 30 mg base (52.6 mg salt) orally once a day

Duration of therapy: 21 days

Comments: In combination with clindamycin, recommended as an alternative regimen for mild-to-moderate Pneumocystis pneumonia (PCP) and moderate-to-severe PCP

Other Comments

Storage requirements:

-Close bottle tightly; protect from light.

General:

-The dose of this drug is often expressed or calculated as the base. Each 26.3 mg tablet of primaquine phosphate is equivalent to 15 mg primaquine base.

-The US CDC recommends screening for G6PD deficiency before starting this drug.

-Current guidelines should be consulted for additional information.

Monitoring:

-Hematologic: Routine blood examinations, especially blood cell counts and hemoglobin values (during therapy)

What is the dose of Primaquine for a child?

Usual Pediatric Dose for Malaria

US CDC Recommendations: 0.5 mg/kg base (0.8 mg/kg salt) orally once a day for 14 days

Maximum dose: 30 mg base/dose

Comments:

-For the radical cure of malaria due to P vivax or P ovale

-Since this drug usually is not active against asexual erythrocytic forms of plasmodia, it should be administered with other appropriate antimalarial agents.

-This drug eradicates any hypnozoites that may be dormant in the liver and, thus, prevent relapses.

Usual Pediatric Dose for Malaria Prophylaxis

US CDC Recommendations: 0.5 mg/kg base (0.8 mg/kg salt) orally once a day

Maximum dose: 30 mg base/dose

Comments:

When used for primary prophylaxis:

-Should be taken 1 to 2 days before travel to malarious areas, while in such areas, and for 7 days after leaving the areas

-Generally used for short-duration travel to areas with primarily P vivax.

When used for terminal prophylaxis (presumptive antirelapse therapy):

-To reduce risk for relapses of malaria due to P vivax or P ovale; indicated for patients with prolonged exposure to P vivax, P ovale, or both

-This drug should be taken for 14 days after the patient has left the malarious area.

-When chloroquine, doxycycline, or mefloquine is used for primary prophylaxis, this drug should be used during the last 2 weeks of postexposure prophylaxis.

-When atovaquone-proguanil is used for prophylaxis, this drug may be used during the last week of atovaquone-proguanil plus an additional 7 days.

-Concurrent use of this drug with the primary prophylaxis agent is preferred; if not possible, this drug should still be used after the primary prophylactic agent has been finished.

Usual Pediatric Dose for Pneumocystis Pneumonia

US CDC, NIH, HIVMA/IDSA, Pediatric Infectious Diseases Society, and American Academy of Pediatrics Recommendations for HIV-exposed and HIV-infected Children: 0.3 mg/kg base (0.526 mg/kg salt) orally once a day

Maximum dose: 30 mg base/dose

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Adolescents: 30 mg base (52.6 mg salt) orally once a day

Duration of therapy: 21 days

Comments:

-In combination with clindamycin, recommended as an alternative regimen for mild-to-moderate PCP (children and adolescents) and moderate-to-severe PCP (adolescents)

-Data not available for children; dosing based on use of these drugs to treat other infections.

How is Primaquine available?

Primaquine is available in the following dosage forms and strengths:

  • Oral tablet,
  • Compounding powder.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Primaquine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

 

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: April 21, 2018 | Last Modified: April 21, 2018

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