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Primaquine Side Effects

It is possible that some side effects of primaquine may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to primaquine: oral tablet

As well as its needed effects, primaquine may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking primaquine, check with your doctor immediately:

More common
  • Back, leg, or stomach pains
  • dark urine
  • fever
  • loss of appetite
  • pale skin
  • unusual tiredness or weakness
Less common
  • Bluish fingernails, lips, or skin
  • difficulty breathing
  • dizziness or lightheadedness
  • Sore throat and fever

Some primaquine side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common
  • Cramps
  • nausea or vomiting

For Healthcare Professionals

Applies to primaquine: compounding powder, oral tablet


The severity of hemolytic anemia in patients with G-6-PD deficiency treated with primaquine is dependent upon the dose given and the patient's ethnic background. In American and African Blacks, hemolytic anemia is generally mild and self-limiting, and lower prophylactic doses of primaquine may be tolerated. In patients of Mediterranean and some Oriental origins, the hemolytic anemia may be severe. Most patients with hemolytic anemia present with dark urine, jaundice, vomiting, and headache.[Ref]

Hematologic side effects have included hemolytic anemia (if administered to patients with glucose-6-phosphate dehydrogenase deficiency [G-6-PD]) and methemoglobinemia in patients with nicotinamide adenine dinucleotide (NADH) methemoglobin reductase deficiency. Leukopenia, mild anemia, and leukocytosis have occasionally been reported.[Ref]


Gastrointestinal side effects have included nausea, vomiting, abdominal cramps, and epigastric distress.[Ref]


Hypersensitivity skin rashes have been reported in approximately 50% of AIDS patients being treated with primaquine and clindamycin for Pneumocystis carinii pneumonia.[Ref]


1. Kantor GS "Primaquine-induced methemoglobinemia during treatment of Pneumocystis carinii pneumonia ." N Engl J Med 327 (1992): 461

2. Ziai M, Amirhakimi GH, Reinhold JG, Tabatabee M, Gettner ME, Bowman JE "Malaria prophylaxis and treatment in G-6-PD deficiency. An observation on the toxicity of primaquine and chloroquine." Clin Pediatr (Phila) 6 (1967): 42-3

3. Fryauff DJ, Baird JK, Basri H, Sumawinata I, Purnomo, Richie TL, Ohrt CK, Mouzin E, Church CJ, Richards AL, Subianto B, Sand "Randomised placebo-controlled trial of primaquine for prophylaxis of falciparum and vivax malaria." Lancet 346 (1995): 1190-3

4. 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." J Trop Med Hyg 95 (1992): 49-51

5. George JN, Sears DA, McCurdy PR, Conrad ME "Primaquine sensitivity in Caucasians: hemolytic reactions induced by primaquine in G-6-PD deficient subjects." J Lab Clin Med 70 (1967): 0-93

6. Kay R, DuBois RE "Clindamycin/primaquine therapy and secondary prophylaxis against Pneumocystis carinii pneumonia in patients with AIDS." South Med J 83 (1990): 03-4

7. Ruf B, Rohde I, Pohle HD "Efficacy of clindamycin/primaquine versus trimethoprim/sulfamethoxazole in primary treatment of Pneumocystis carinii pneumonia." Eur J Clin Microbiol Infect Dis 10 (1991): 07-10

8. Freedman DO "Clinical practice. Malaria prevention in short-term travelers." N Engl J Med 359 (2008): 603-12

9. Bolchoz LJC, Budinsky RA, McMillan DC, Jollow DJ "Primaquine-induced hemolytic anemia: formation and hemotoxicity of the arylhydroxylamine metabolite 6-methoxy-8-hydroxylaminoquinoline." J Pharmacol Exp Ther 297 (2001): 509-15

10. Baird JK, Fryauff DJ, Basri H, Bangs MJ, Subianto B, Wiady I, Purnomo, Leksana B, Masbar S, Richie TL, Jones TR, Tjitra E, "Primaquine for prophylaxis against malaria among nonimmune transmigrants in irian jaya, indonesia." Am J Trop Med Hyg 52 (1995): 479-84

11. Black JR, Feinberg J, Murphy RL, Fass RJ, Finkelstein D, Akil B, Safrin S, Carey JT, Stansell J, Plouffe JF, He WL, Shelto "Clindamycin and primaquine therapy for mild-to-moderate episodes of pneumocystis carinii pneumonia in patients with AIDS: AIDS clinical trials group 044." Clin Infect Dis 18 (1994): 905-13

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