Primaquine Dosage
This dosage information may not include all the information needed to use Primaquine safely and effectively. See additional information for Primaquine.
The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.
Usual Adult Dose for:
Usual Pediatric Dose for:
Additional dosage information:
Usual Adult Dose for Malaria
Manufacturer recommendation: 15 mg base (26.3 mg salt) orally once a day for 14 days
Centers for Disease Control and Prevention (CDC) recommendation: 30 mg base (52.6 mg salt) orally once a day for 14 days; for patients with borderline glucose-6-phosphate dehydrogenase (G6PD) deficiency or as an alternative regimen, 45 mg base (78.9 mg salt) orally once a week for 8 weeks has been recommended
Usual Adult Dose for Malaria Prophylaxis
Primary prophylaxis of malaria (including chloroquine-resistant malaria):
CDC recommendation: 30 mg base (52.6 mg salt) orally once a day
Primaquine should be taken 1 to 2 days before travel to malarious areas, while in such areas, and for 7 days after leaving the areas. It is generally used for short-duration travel to areas with primarily P vivax.
Terminal prophylaxis of P vivax or P ovale malaria:
Manufacturer recommendation: 15 mg base (26.3 mg salt) orally once a day for 14 days
CDC recommendation: 30 mg base (52.6 mg salt) orally once a day for 14 days
Usual Adult Dose for Pneumocystis Pneumonia
15 to 30 mg base (26.3 to 52.6 mg salt) orally once a day for 21 days; effective in combination with clindamycin
Primaquine plus clindamycin is recommended as an alternative regimen by the CDC, National Institutes of Health (NIH), and Infectious Diseases Society of America (IDSA). Seriously ill patients should receive IV trimethoprim-sulfamethoxazole or pentamidine therapy.
Usual Pediatric Dose for Malaria
Manufacturer recommendation: 0.3 mg/kg base (0.526 mg/kg salt) orally once a day for 14 days (not to exceed 15 mg base/day)
CDC recommendation: 0.5 mg/kg base (0.88 mg/kg salt) orally once a day for 14 days (not to exceed 30 mg base/day); for patients with borderline G6PD deficiency or as an alternative regimen, 0.75 mg/kg base (1.3 mg/kg salt) orally once a week for 8 weeks (not to exceed 45 mg base/week) has been recommended
Usual Pediatric Dose for Malaria Prophylaxis
Primary prophylaxis of malaria (including chloroquine-resistant malaria):
CDC recommendation: 0.5 mg/kg base (0.88 mg/kg salt) orally once a day (not to exceed 30 mg base/day)
Primaquine should be taken 1 to 2 days before travel to malarious areas, while in such areas, and for 7 days after leaving the areas. It is generally used for short-duration travel to areas with primarily P vivax.
Terminal prophylaxis of P vivax or P ovale malaria:
Manufacturer recommendation: 0.3 mg/kg base (0.526 mg/kg salt) orally once a day for 14 days (not to exceed 15 mg base/day)
CDC recommendation: 0.5 mg/kg base (0.88 mg/kg salt) orally once a day for 14 days (not to exceed 30 mg base/day)
Usual Pediatric Dose for Pneumocystis Pneumonia
0.3 mg/kg base (0.526 mg/kg salt) orally once a day for 21 days (not to exceed 30 mg base/day); effective in combination with clindamycin
Primaquine plus clindamycin is recommended as an alternative regimen by the CDC, NIH, IDSA, Pediatric Infectious Diseases Society, and American Academy of Pediatrics. Seriously ill patients should receive IV trimethoprim-sulfamethoxazole or pentamidine therapy.
Renal Dose Adjustments
Data not available
Liver Dose Adjustments
Data not available
Precautions
Primaquine is contraindicated in patients with systemic diseases with tendencies to develop granulocytopenia (i.e., lupus erythematosus and rheumatoid arthritis) and in patients taking other potentially hemolytic drugs or bone marrow suppressants.
Because quinacrine appears to potentiate the toxicity of antimalarial compounds which are structurally related to primaquine, the use of quinacrine in patients administered primaquine is contraindicated. Similarly, primaquine should not be given to patients who have received quinacrine recently, as toxicity is increased.
The CDC recommends screening for G6PD deficiency prior to initiating treatment with primaquine. Individuals with G6PD deficiency or nicotinamide adenine dinucleotide (NADH) methemoglobin reductase deficiency may develop hemolytic anemia, leukopenia, or methemoglobinemia while receiving primaquine. If evidence of hemolytic anemia is present (darkening of urine, marked fall of hemoglobin or erythrocytic count), primaquine should be discontinued immediately.
Patients with previous idiosyncratic reactions to primaquine, a family or personal history of favism, G6PD deficiency, or NADH methemoglobin reductase deficiency should be closely monitored for signs of hemolytic anemia.
The recommended dose and duration should not be exceeded because anemia, methemoglobinemia, and leukopenia have occurred with large doses. Blood cell counts and hemoglobin should be monitored during therapy.
Clinical studies of primaquine did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. Other clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for elderly patients should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Dialysis
Data not available
Other Comments
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.
Since primaquine usually is not active against asexual erythrocytic forms of plasmodia, it should be administered with other appropriate antimalarial agents for the treatment of P vivax or P ovale malaria. Primaquine is used to eradicate any hypnozoites that may be dormant in the liver and, thus, prevent relapses.
In general, when used to prevent delayed primary attacks or relapse of P vivax or P ovale malaria, 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.
