primaquine

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

What is primaquine?

Primaquine is an antimalarial drug. The exact way that primaquine works is unknown.

Primaquine is used to treat and prevent malaria.

Primaquine may also be used for purposes other than those listed in this medication guide.

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

Notify your doctor if your urine turns dark.

Use caution when driving or performing other hazardous activities until you know how this medication affects you. Primaquine may cause visual disturbances such as blurred vision, misty vision, and difficulty focusing. Report any vision or hearing changes to your doctor.

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Who should not take primaquine?

Before taking this medication, tell your doctor if you have

  • a history of an allergic reaction to previous primaquine therapy,

  • glucose-6-phosphate dehydrogenase (G-6-PD) deficiency,

  • rheumatoid arthritis,

  • lupus erythematosus, or

  • quinacrine (Atabrine) therapy.

You may not be able to take primaquine, or you may require a lower dose or special monitoring during your therapy if you have any of the conditions listed above.

It is not known whether primaquine will harm an unborn baby. Do not take primaquine without first talking to your doctor if you are pregnant.

It is not known how primaquine will affect a nursing baby. Do not take primaquine without first talking to your doctor if you are breast-feeding a baby.

How should I take primaquine?

Take primaquine exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water.

Take primaquine with food to lessen stomach upset.

Store primaquine at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and only take your next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose?

Seek emergency medical attention.

Symptoms of a primaquine overdose include nausea, vomiting, stomach upset, and stomach cramps.

What should I avoid while taking primaquine?

Use caution when driving or performing other hazardous activities until you know how this medication affects you. Primaquine may cause visual disturbances such as blurred vision, misty vision, and difficulty focusing. Report any vision or hearing changes to your doctor.

Primaquine side effects

Stop taking primaquine and seek emergency medical attention if you experience an allergic reaction (flushing; swelling of your lips, tongue, or face, difficulty breathing; closing of your throat; vision problems; a rash; or itching).

Notify your doctor if you experience darkening of your urine.

Nausea, stomach pain or upset, vomiting, and loss of appetite may also occur during therapy.

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?

Do not take primaquine if you have recently taken quinacrine (Atabrine). These two drugs are similar and can cause dangerous side effects if they are taken together.

Drugs other than those listed here may also interact with primaquine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

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: 4.02. Revision Date: 2010-12-15, 5:01:39 PM.

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