Primaquine Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Malaria

Manufacturer Recommendations:
Radical cure of Plasmodium vivax malaria: 15 mg base (26.3 mg salt) orally once a day for 14 days

Comments:
-Recommended only for the radical cure of P vivax malaria, the prevention of relapse in P vivax malaria, or after the end of chloroquine phosphate suppressive therapy in P vivax malaria-endemic area.
-Should be given with chloroquine phosphate (destroys erythrocytic parasites and stops attack) to destroy exoerythrocytic parasites.

Approved indication: For the radical cure (prevention of relapse) of P vivax malaria

Centers for Disease Control and Prevention (CDC) Recommendations:
Radical cure of P vivax or P ovale malaria: 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:
-Since primaquine usually is not active against asexual erythrocytic forms of plasmodia, it should be administered with other appropriate antimalarial agents.
-Primaquine is used to eradicate 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.

Usual Adult Dose for Malaria Prophylaxis

Manufacturer Recommendations:
Prevention of relapse of P vivax malaria: 15 mg base (26.3 mg salt) orally once a day for 14 days

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

Approved indication: For the radical cure (prevention of relapse) of P vivax malaria

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

Comments:
-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.

Terminal prophylaxis (presumptive antirelapse therapy) for P vivax or P ovale malaria: 30 mg base (52.6 mg salt) orally once a day for 14 days

Comments:
-Primaquine should be taken for 14 days after the patient has left the malarious area.
-When chloroquine, doxycycline, or mefloquine is used for primary prophylaxis, primaquine should be used during the last 2 weeks of postexposure prophylaxis.
-When atovaquone-proguanil is used for prophylaxis, primaquine may be used during the last week of atovaquone-proguanil plus an additional 7 days.
-Concurrent use of primaquine with the primary prophylaxis agent is preferred; however, if that is not possible, primaquine should still be used after the primary prophylactic agent has been finished.

Usual Adult Dose for Pneumocystis Pneumonia

(Not approved by FDA)

CDC Recommendations for HIV-infected Patients: 15 to 30 mg base (26.3 to 52.6 mg salt) orally once a day with clindamycin
Duration of therapy: 21 days

Comments:
-Primaquine plus clindamycin is recommended as an alternative regimen.
-Seriously ill patients should receive IV trimethoprim-sulfamethoxazole or pentamidine therapy.

Usual Pediatric Dose for Malaria

(Not approved by FDA)

CDC Recommendations:
Radical cure of P vivax or P ovale malaria: 0.5 mg/kg base (0.88 mg/kg salt) orally once a day for 14 days
Maximum dose: 30 mg base/day

Comments:
-Since primaquine usually is not active against asexual erythrocytic forms of plasmodia, it should be administered with other appropriate antimalarial agents.
-Primaquine is used to eradicate any hypnozoites that may be dormant in the liver and, thus, prevent relapses.

Usual Pediatric Dose for Malaria Prophylaxis

(Not approved by FDA)

CDC Recommendations:
Primary prophylaxis: 0.5 mg/kg base (0.88 mg/kg salt) orally once a day
Maximum dose: 30 mg base/day

Comments:
-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.

Terminal prophylaxis (presumptive antirelapse therapy) for P vivax or P ovale malaria: 0.5 mg/kg base (0.88 mg/kg salt) orally once a day for 14 days
Maximum dose: 30 mg base/day

Comments:
-Primaquine should be taken for 14 days after the patient has left the malarious area.
-When chloroquine, doxycycline, or mefloquine is used for primary prophylaxis, primaquine should be used during the last 2 weeks of postexposure prophylaxis.
-When atovaquone-proguanil is used for prophylaxis, primaquine may be used during the last week of atovaquone-proguanil plus an additional 7 days.
-Concurrent use of primaquine with the primary prophylaxis agent is preferred; however, if that is not possible, primaquine should still be used after the primary prophylactic agent has been finished.

Usual Pediatric Dose for Pneumocystis Pneumonia

(Not approved by FDA)

CDC Recommendations:
HIV-exposed and HIV-infected infants and children: 0.3 mg/kg base (0.526 mg/kg salt) orally once a day with clindamycin
Maximum dose: 30 mg base/day

HIV-infected adolescents: 15 to 30 mg base (26.3 to 52.6 mg salt) orally once a day with clindamycin

Duration of therapy: 21 days

Comments:
-Primaquine plus clindamycin is recommended as an alternative regimen.
-Seriously ill patients should receive IV trimethoprim-sulfamethoxazole or pentamidine therapy.
-Data not available for children; dosing based on use of these drugs for treating other infections.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Data not available

Other Comments

General:
-The dosage of primaquine is often expressed or calculated as the base. Each 26.3 mg tablet of primaquine phosphate is equivalent to 15 mg base.
-The CDC recommends screening for G6PD deficiency prior to initiating treatment with primaquine.

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

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