Generic
Primaquine
3 brands available in the market
At a glance
Primaquine is an antiparasitic medication used for radical cure of vivax and ovale malaria, as a gametocytocidal drug in P. falciparum infections, and for terminal prophylaxis after leaving a malarious area. It eliminates the exoerythrocytic forms of the malaria parasite.
Description
Primaquine is an 8-aminoquinoline antimalarial that eliminates the exoerythrocytic forms of P. vivax, P. ovale, and P. falciparum. It disrupts mitochondria and binds to DNA, destroying the parasite. This achieves radical cure of vivax malaria and is also active against gametocytes of P. falciparum.
Indications
- Radical cure of P. vivax and P. ovale malaria
- Gametocytocidal drug in P. falciparum infections
- Terminal prophylaxis after leaving a malarious area
Therapeutic class
Anti-malarial drugs
Pharmacological class
8-Aminoquinoline Antimalarial
Pharmacology
Primaquine disrupts mitochondria and binds to DNA, eliminating exoerythrocytic forms of malaria parasites. It provides radical cure for P. vivax and P. ovale, preventing relapses, and destroys P. falciparum gametocytes to prevent transmission.
Mechanism of action
Eliminates exoerythrocytic forms of malaria parasites by disrupting mitochondria and DNA.
Dosage
Adult Dose (Oral):
- P. vivax/ovale malaria: 30 mg/day for 14 days with chloroquine
- Uncomplicated P. vivax/ovale: 45 mg/day for 8 weeks (mild G6PD deficiency)
- Chemoprophylaxis: 30 mg/day for 14 days after leaving malaria-endemic area
- Gametocytocide: 30-40 mg single dose
Pediatric Dose (Oral):
- P. vivax/ovale malaria: 0.5 mg/kg/day (max 30 mg/day) for 14 days
- Chemoprophylaxis: 0.5 mg/kg/day (max 30 mg/day); start 1-2 days prior to travel and continue for 7 days after departure
Administration
- Take with food (to decrease stomach upset)
- Swallow tablet whole; do not chew, crush, or break
Missed dose
If you miss a dose, take it as soon as you remember; skip if it's almost time for next dose; do not double the dose.
Side effects
Side Effects:
- Abdominal pain and gastric distress (on empty stomach)
- Nausea, vomiting
- Methemoglobinemia (occasional)
- Hemolytic anemia (in G6PD deficiency)
- Headache
- Dizziness
- Rash
Precautions & warnings
- May affect driving ability; do not drive if drowsy or dizzy
- Test for G6PD deficiency; discontinue if signs of hemolysis occur
- Monitor blood sugar in diabetic patients
- Monitor blood cell counts with long-term use
Contraindications
- Hypersensitivity to primaquine
- Children under 1 year
- Acute flare-ups of systemic diseases (RA, SLE)
- Pregnancy and lactation
Drug interactions
- Chloroquine: Primaquine may inhibit metabolism of chloroquine
- Mepacrine: May potentiate primaquine toxicity
- Sulfonamides, nitrofurans: Risk of hemolysis
- Avoid ethanol
- Potentially fatal: Concurrent use with hemolytic drugs and bone marrow suppressants (methotrexate, phenylbutazone, chloramphenicol)
Food interactions
Alcohol consumption with Primaquine is unsafe.
Use in pregnancy
Use in Pregnancy: Unsafe during pregnancy; definite evidence of risk; may cause transplacental hemolytic anemia in G6PD-deficient fetus.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Probably safe; limited human data suggests no significant risk; primaquine enters breast milk; mothers should not breastfeed.
Pediatric use
Do not use in children under 1 year.
Geriatric use
Caution required in elderly patients; dose adjustment may be needed.
Renal / hepatic impairment
Renal Impairment: Limited information on use in kidney disease; consult your doctor.
Hepatic Impairment: Limited information on use in liver disease; consult your doctor.
Overdose effects
Overdose: Abdominal cramps, vomiting, epigastric distress, CNS and cardiovascular disturbances, cardiac arrhythmia, QT prolongation, cyanosis, methemoglobinemia, granulocytopenia, acute hemolysis (G6PD); treatment: discontinue drug.
Storage conditions
Store at 25°C; protect from light.
Chemical structure
Primaquine