II. Indications

  1. Malaria Prophylaxis in regions with Plasmodium Vivax transmission
    1. Postexposure prevention for "relapsing" Malaria
    2. Eradication of Malaria liver involvement

III. Contraindications

  1. G6PD Deficiency
    1. Results in acute Hemolysis

IV. Mechanism

  1. Synthetic, 8-aminoquinoline derivative
  2. Activate against tissue Malarial infection including late liver stages (hypnozoites, schizonts)
  3. Binds Protozoal DNA, and cross-links glutathione

V. Medications

  1. Primaquine Phosphate Tablets 15 mg base (26.3 mg salt)
    1. Base 0.57 mg = Salt 1 mg
  2. General
    1. May take with or without food
    2. Take with food to reduce gastric irritation

VI. Dosing: P. Vivax or P. Ovale Malaria Prophylaxis

  1. Start 1-2 days before travel and continue until 7 days after return (14 days after an extended stay)
  2. Adult: 30 mg base (52.6 mg salt) daily
  3. Child: 0.5 mg/kg up to 30 mg base (0.8 mg/kg up to 52.6 mg salt)

VII. Dosing: P. Vivax or P. Ovale Malaria Treatment

  1. Follows primary treatment to reduce risk of relapsing infection
  2. Adult: 30 mg base (52.6 mg salt) orally daily for 14 days after initial course
  3. Child: 0.5 mg/kg base up to 30 mg/day (0.8 mg/kg salt) orally daily for 14 days after initial course

VIII. Adverse Effects

  1. Gastrointestinal (esp. on an empty Stomach, take with food)
    1. Abdominal Pain
    2. Nausea
    3. Vomiting
  2. Other
    1. QTc Prolongation

IX. Safety

  1. Considered safe in Lactation
  2. Pregnancy Category X
    1. Avoid in all trimesters of pregnancy
    2. Use Contraception while taking Primaquine
  3. Safe in children age >1 month old (not with G6PD Deficiency)
    1. Not recommended in Malaria Prophylaxis in treatment

XI. References

  1. (2019) Drugs for Malaria Prophylaxis, Med Lett Drugs Ther, p. e104-5
  2. (2023) Presc Lett, Malaria Prophylaxis, Resource #350806
  3. Sanford (2016) Am Fam Physician 94(8): 620-7 [PubMed]

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