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primaquine

Generic Name: primaquine (PRIM a kwin)
Brand Name:

What is primaquine?

Primaquine is a medication to treat or prevent malaria, a disease caused by parasites. This medicine works by interfering with the growth of parasites in the body.

Parasites that cause malaria typically enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia.

Vivax malaria is a form of malaria in which parasites travel from the bloodstream into other cells and tissues of the body. This can cause a second infection (relapse) to occur.

Primaquine is used to prevent malaria from coming back in people who have been infected with the vivax form of this disease.

Primaquine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about primaquine?

You should not use primaquine if you have an autoimmune disorder, such as lupus or rheumatoid arthritis, or if you also use quinacrine (Atabrine).

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What should I discuss with my healthcare provider before taking primaquine?

You should not use primaquine if you are allergic to it, or if you have:

  • an autoimmune disorder, such as lupus or rheumatoid arthritis; or

  • if you have recently used another malaria medicine called quinacrine or Atabrine.

To make sure primaquine is safe for you, tell your doctor if you have:

  • a genetic enzyme deficiency called glucose-6-phosphate dehydrogenase (G6PD) deficiency;

  • heart disease, heart rhythm disorder (including slow heartbeats);

  • long QT syndrome;

  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  • a personal or family history of becoming ill after eating fava beans; or

  • if you are of a certain ethnic background (Southern Europe, Mediterranean, Middle Eastern, African, Southeast Asian, Oceanic).

Do not use primaquine if you are pregnant. It could harm the unborn baby.

It is not known whether primaquine passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I take primaquine?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

The usual dose of primaquine is 1 tablet daily for 14 days.

Take primaquine for the entire length of time prescribed by your doctor. If you are taking this medicine to treat malaria, your symptoms may get better before the infection is completely treated.

Talk to your doctor if you stop taking this medicine early for any reason.

No medicine is 100% effective in treating or preventing malaria. For best results, keep taking primaquine as directed.

Contact your doctor as soon as possible if you have been exposed to malaria, or if you have fever or other symptoms of illness during or after a stay in an area where malaria is common.

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.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include vomiting, heartburn, stomach cramps, weakness, pale skin, and blue lips or fingernails.

What should I avoid while taking primaquine?

This medicine may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Primaquine side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop taking primaquine and call your doctor at once if you have:

  • fever;

  • dark colored urine;

  • pale or yellowed skin; or

  • confusion or weakness.

Also call your doctor at once if you have:

  • low red blood cells (anemia)--pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating.

Common side effects may include:

  • nausea, vomiting;

  • stomach cramps; or

  • upset stomach.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Primaquine dosing 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.

What other drugs will affect primaquine?

Primaquine can cause a serious heart problem, especially if you use certain medicines at the same time, including antibiotics, antidepressants, heart rhythm medicine, antipsychotic medicines, and medicines to treat cancer, malaria, HIV or AIDS. Tell your doctor about all medicines you use, and those you start or stop using during your treatment with primaquine.

This list is not complete. Other drugs may interact with primaquine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about primaquine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 5.01. Revision Date: 2015-05-19, 9:50:42 AM.

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