This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Men should continue to use birth control for at least 3 months after the end of treatment. If you become pregnant or think you may be pregnant, tell your doctor right away. This article is published under license to BioMed Central Ltd. Malaria Malaria Prophylaxis Pneumocystis Pneumonia warnings What is the most important information I should know about Primaquine? Poespoprodjo JR, Fobia W, Kenangalem E, Lampah DA, Hasanuddin A, Warikar N, Seal A, McGready R, Sugiarto P, Tjitra E, Anstey NM, Price RN. Get medical help right away if you have any very serious side effects, including: fast/irregular heartbeat, severe dizziness, fainting. WebMD does not provide medical advice, diagnosis or treatment. Each pink, film-coated, convex, round tablet, imprinted in black ink with a stylized "W" and "P97" on one side and plain on the other side, contains 26.3 mg of primaquine phosphate USP (equivalent to 15 mg of primaquine base). Side Effects Print Save Primaquine Side Effects Medically reviewed by Drugs.com. As a gametocytocide in P. falciparum infections, only one dose of primaquine is given (traditionally 0.5-0.75mg base/kg, recently reduced to 0.25mg base/kg) [7]. This is exploited in the once weekly 0.75-mg base/kg radical cure regimen recommended for patients with vivax malaria and mild G6PD variants [2, 28], and the interrupted MDA regimens. Wear long-sleeved shirts or blouses and long trousers to protect your arms and legs, especially from dusk through dawn when mosquitoes are out. Haemolytic risks vary widely as there is also substantial variability in G6PD activity between individuals with the same genotype, and even within the same individual over time. Received 2014 Aug 23; Accepted 2014 Oct 25. The once-weekly regimen was evaluated in a relatively small number of adults with the A- variant, and there is little published information on its use in other G6PD variants (most of which are more severe than A-). The CDC recommends continuing your other malaria treatment (such as chloroquine) throughout pregnancy until delivery to prevent harm to your unborn baby (hemolytic anemia). Warning Oral route (Tablet) Malaria is common in areas such as Africa, South America, and Southern Asia. Call your doctor for medical advice about side effects. Do not start, stop, or change the dosage of any medicines without your doctor's approval. Changes in malaria incidence after mass drug administration in Nicaragua. Severe haemolytic reactions can still occur in G6PDA-, but they are much less frequent. Reeve PA, Toaliu H, Kaneko A, Hall JJ, Ganczakowski M "Acute intravascular haemolysis in Vanuatu following a single dose of primaquine in individuals with glucose-6-phosphate dehydrogenase deficiency." Keep from freezing. This medication must not be used during pregnancy. Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. George JN, Sears DA, McCurdy PR, Conrad ME "Primaquine sensitivity in Caucasians: hemolytic reactions induced by primaquine in G-6-PD deficient subjects." History. In Sardinia 19 healthy individuals with presumed Mediterranean type G6PD deficiency were given primaquine 45mg and chloroquine 300mg; the median [range] fall in haematocrit was 8% [6-19%] [18]. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Other side effects not listed may also occur in some patients. Kellermeyer RW, Tarlov AR, Schrier SL, Carson PE, Alving AS. G6PD testing is, therefore, considered unnecessary. Kellermeyer RW, Tarlov AR, Brewer GJ, Carson PE, Alving AS. Tell your doctor about all medicines you use, and those you start or stop using during your treatment with primaquine. 5705185. Along with its needed effects, a medicine may cause some unwanted effects. This can cause a second infection (relapse) to occur. [2] Safety of 8-Aminoquinoline Antimalarial Medicines. Primaquine should not be taken for more than 14 days for malaria treatment. All rights reserved. [2] Specifically it is used for malaria due to Plasmodium vivax and Plasmodium ovale along with other medications and for prevention if other options cannot be used. The UK is the first country to allow OTC access to Sanofi's tadalafil-based erectile dysfunction drug Cialis following a successful switch. Allergic reactions and neuropsychiatric symptoms have been reported rarely in association with primaquine use. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Single Dose Primaquine as a Gametocytocide in Plasmodium Falciparum Malaria; Updated WHO Policy Recommendation. Primaquine then kills the malaria parasites living in other. The first mass use of primaquine was in the Korean War. Write a review. Kay R, DuBois RE "Clindamycin/primaquine therapy and secondary prophylaxis against Pneumocystis carinii pneumonia in patients with AIDS." The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Women should continue to use birth control for at least 1 menstrual cycle after the end of treatment. An observation on the toxicity of primaquine and chloroquine." This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. All but one death followed multiple dosing to prevent vivax malaria relapse. Properly discard this product when it is expired or no longer needed. Malaria prevention in short-term travelers." Primaquine is in a class of medications called antimalarials. Copyright 1996-2023 Cerner Multum, Inc. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Are patients with malaria at greater or lesser risk of haemolysis than healthy subjects? Taking 30mg/day for 14days in the African A- variant resulted in approximately the same degree of haemolysis as 15mg/day in the Mahidol or Viengchan variants, with no further decline in haemoglobin during the second week of drug administration (Figure1). Limit alcoholic beverages. Poor adherence is an important cause of reduced effectiveness. 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). Primaquine has been proposed as a major agent to prevent relapse after therapy of acute attacks . This was 15mg primaquine (adult dose) once daily for four days, followed by three days without drug, then primaquine for a further ten days [27]. Parasites that cause malaria typically enter the body through the bite of a mosquito. The most seve [Skip to Navigation] . How Primaquine works Primaquine is an antimalarial medication. Fernando Cobo, in Imported Infectious Diseases, 2014. Bennett JW, Pybus BS, Yadava A, Tosh D, Sousa JC, McCarthy WF, Deye G, Melendez V, Ockenhouse CF. Cerner Multum, Inc. "Australian Product Information." Primaquine to prevent transmission of falciparum malaria. Primaquine is used to prevent malaria from coming back in people who have been infected with the vivax form of this disease. Primaquine may cause a condition that affects the heart rhythm (QT prolongation). Again, although commonly recommended in Asia and the Americas, it is uncertain how many millions have received this treatment over the past 60years. Primaquine as a gametocytocide has usually been recommended in areas of low transmission where the haemoglobin nadir from malaria occurs around day 7. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. Do not double doses. Canada residents can call a provincial poison control center. Primaquine is a medication used to treat and prevent malaria and to treat Pneumocystis pneumonia. The dosage is based on the kind of infection you have and your response to treatment. Stop taking primaquine and call your doctor at once if you have: Common side effects of primaquine may include: This is not a complete list of side effects and others may occur. The amount of medicine that you take depends on the strength of the medicine. Your infection may not clear up if you stop using this medicine too soon. Using this medicine with any of the following medicines is not recommended. For the malaria control programme manager considering recommending primaquine as a gametocytocide in falciparum malaria, the assessment of risk is easier, whilst that of benefit is more difficult. Clinical considerations of the primaquine-type hemolysis. No drug treatment is completely effective in preventing malaria. Do not keep outdated medicine or medicine no longer needed. The risk of relapse of Plasmodium vivax malaria without primaquine therapy ranged from 5% to 80% or more . We comply with the HONcode standard for trustworthy health information. NJW was co-chairman of the Primaquine Evidence Review group of the WHO in 2012, is a member of the WHO Policy Advisory Committee and co-chairs the WHO Malaria Treatment Guidelines Committee. May cause hemolytic anemia in patients with these conditions. Multiple relapses cause substantial morbidity, interfering with development and educational performance in children, causing abortion and intra-uterine growth retardation in pregnancy and contributing to life-threatening anaemia in young children in higher transmission settings [39, 40] When relapse rates exceed 50% (e.g., in east Asia and Oceania), effective radical curative treatment more than halves the incidence of vivax malaria [41]. However, further haemolysis does occur if higher doses of primaquine are given [16]. The relationships between primaquine dose, duration and haemolysis were characterized in detail for the G6PD A-variant in healthy adult volunteers. Talk to your doctor if you stop taking this medicine early for any reason. In addition to taking primaquine, use protective clothing, insect repellents, and mosquito netting around your bed to further prevent mosquito bites that could cause malaria. Nicholas J White, Email: ca.serdemport@wkcin. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Almost all the probable primaquine overdose (95.5%) SAEs were in children; most from a single case series of 21 Sri Lankan children aged two to 12years hospitalized with acute intravascular haemolysis. if you are of a certain ethnic background (Southern Europe, Mediterranean, Middle Eastern, African, Southeast Asian, Oceanic). Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. Point-of-care tests with similar performance characteristics to the spot test have been developed recently [38]. 8600 Rockville Pike The presence of other medical problems may affect the use of this medicine. Drug interactions may change how your medications work or increase your risk for serious side effects. "Product Information. The downside is that they cause haemolysis in people who are glucose-6-phosphate dehydrogenase (G6PD) deficient. Primaquine was officially licensed as an anti-malarial drug by the FDA in 1952. Individuals with CYP2D6 genetic polymorphisms conferring reduced enzyme activity may have reduced primaquine efficacy [35, 36]. Ziai M, Amirhakimi GH, Reinhold JG, Tabatabee M, Gettner ME, Bowman JE. 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). Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. The most common severe adverse event (SAE) following primaquine is severe intravascular haemolysis with dark or black urine and mild jaundice. It also prevents the development of the blood forms of the parasite, which are . An observation on the toxicity of primaquine and chloroquine. This list is not complete. J Pharmacol Exp Ther 297 (2001): 509-15, 10. Malaria parasites can enter the body through these mosquito . Medically reviewed by Drugs.com on Aug 1, 2022. Bolchoz LJC, Budinsky RA, McMillan DC, Jollow DJ "Primaquine-induced hemolytic anemia: formation and hemotoxicity of the arylhydroxylamine metabolite 6-methoxy-8-hydroxylaminoquinoline." Do not store in the bathroom. Take with food to prevent stomach upset. In the 1970s, some 28 million people in the Chinese Province of Jiangsu alone received mass preventive radical treatment regimens [3], which suggests that as many as 100 million people or more may have been treated in the entire country. Some methaemoglobinaemia is common, but very seldom is dangerous. In 5,192 patients treated with mefloquine-sulphadoxine-pyrimethamine and primaquine (45mg, average weight 50kg: 0.9mg base/kg) on the northwestern border of Thailand (G6PD-deficiency prevalence mainly Mahidol variant ~10%) no fatalities and no serious haemolysis was reported [30]. Shekalaghe SA, ter Braak R, Daou M, Kavishe R, van den Bijllaardt W, van den Bosch S, Koenderink JB, Luty AJ, Whitty CJ, Drakeley C, Sauerwein RW, Bousema T. In Tanzania, hemolysis after a single dose of primaquine coadministered with an artemisinin is not restricted to glucose-6-phosphate dehydrogenase-deficient (G6PD A-) individuals. Medically reviewed by Drugs.com. official website and that any information you provide is encrypted Cappellini MD, Fiorelli G. Glucose-6-phosphate dehydrogenase deficiency. Malaria is a disease that's spread to humans by a bite from a mosquito that's infected with a parasite called Plasmodium vivax. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. The 8-aminoquinolines have unique anti-malarial properties, but they also pose particular safety problems. Your doctor may order a blood test to see if you have any enzyme deficiency before starting primaquine. This document does not contain all possible drug interactions. JR and EAA performed the literature search. Talk to your doctor if you have concerns about this. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Clindamycin alone was also ineffective. Primaquine systemic 26.3 mg (15 mg base) (W P97). None required a blood transfusion [17]. Quick treatment of malaria infection is needed to prevent serious, possibly fatal, outcomes. HHS Vulnerability Disclosure, Help Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. The reported deaths occurred mainly in countries with a minority of the global malaria burden, which does raise concern about the generalizability of this estimate. The majority of the SAEs were haemolysis, giving an estimated incidence of 1.8 episodes of severe haemolysis per million people receiving radical curative regimens of primaquine as MDA. 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