Primaquine
✅ Malaria treatment
✅ Voorkomt terugval
✅ Eradicates parasites
✅ Stops transmission
✅ Shortens illness duration
Primaquine contains Primaquine Phosphate.
✓ Medisch beoordeeld door Morgan Ellis — Apotheekonderzoeker · 8 jaar ervaring · Laatst beoordeeld: mei 2026
Snelle antwoord
Primaquine bevat primaquine phosphate 15 mg base (Sanofi India). It is the only widely-stocked drug capable of radical cure of P. vivax and P. ovale relapsing malaria — it kills the dormant hypnozoite liver stage that other antimalarials do not touch. Standard regimen: 30 mg base/day for 14 days after a 3-day course of chloroquine has cleared the blood stage. Also used for P. falciparum gametocyte clearance (single 0.25 mg/kg dose, transmission-blocking) and as an option for Pneumocystis jirovecii pneumonia in sulfa-allergic patients (with clindamycin). Verplichte G6PD-test voor gebruik — primaquine causes severe haemolytic anaemia in G6PD-deficient patients. Take with food to reduce GI upset.
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About Primaquine
Primaquine is a 15 mg primaquine phosphate (base) tablet manufactured by Sanofi India under WHO-GMP certified conditions. Primaquine is an 8-aminoquinoline first developed by the US military in World War II. It is on the WHO Essential Medicines list and remains the only widely-available drug that kills the dormant hypnozoite liver stage of P. vivax en P. ovale — without a primaquine course these parasites can relapse weeks to months after blood-stage treatment.
How primaquine works
Primaquine’s exact molecular target is incompletely characterised — the leading hypothesis is that one of its CYP2D6-generated metabolites generates reactive oxygen species and free radicals that damage the parasite mitochondrial membrane in the liver-stage hypnozoite. The same oxidative chemistry is what damages G6PD-deficient red blood cells (where reduced glutathione cannot regenerate to neutralise oxidative stress) — explaining the parallel between primaquine’s antiparasitic activity and its haemolytic toxicity.
Primaquine has weak activity on blood-stage parasites — pair it with chloroquine (in chloroquine-sensitive vivax/ovale areas) or with an artemisinin combination therapy to first clear the blood stage. Primaquine alone is NOT a treatment for acute symptomatic malaria.
Indicaties en dosering
| Indicatie | Dose (in mg base) | Opmerkingen |
|---|---|---|
| P. vivax / P. ovale radical cure (G6PD-normal) | 30 mg base/day for 14 days | After blood-stage treatment with chloroquine (or ACT). Adherence to all 14 days is essential — premature stop is the commonest reason for relapse. |
| P. vivax in tropical / Oceanian strains (Chesson-like, more relapse-prone) | 30 mg base/day for 14 days, sometimes extended to 21 days at specialist discretion | Higher cumulative dose for chloroquine-resistant or hypnozoite-rich strains. |
| P. vivax radical cure (G6PD intermediate) | 0.75 mg/kg once weekly × 8 weeks | Specialist-supervised. Requires haematology follow-up. |
| P. falciparum gametocyte clearance (transmission-blocking, WHO low-dose) | 0.25 mg/kg single dose with ACT | Even in G6PD-deficient patients the haemolysis risk is low at this single dose. |
| Pneumocystis jirovecii pneumonia (PJP) — alternative to TMP-SMX in sulfa allergy | 30 mg base/day with clindamycin 600 mg PO TID for 21 days | Specialist HIV / immunocompromised host context. |
| Paediatric vivax radical cure (≥ 6 months, G6PD-normal) | 0.5 mg/kg/day for 14 days (max 30 mg/day) | Tablet-splitting may be needed. |
Bijwerkingen
- Common (5–15 %): nausea, abdominal cramping, headache, dizziness — almost all reduced by taking with food.
- Minder vaak: mild methaemoglobinaemia (cyanosis at high doses, especially in patients with NADH cytochrome b5 reductase deficiency), pruritus, leucopenia, anaemia.
- Severe (in G6PD-deficient patients): acute intravascular haemolytic anaemia presenting as dark urine, jaundice, fatigue, pallor, dyspnoea — discontinue and seek immediate medical evaluation.
- Zeldzaam: severe methaemoglobinaemia, agranulocytosis, hypertension.
Geneesmiddelinteracties
| Interactie | Effect | Beheer |
|---|---|---|
| Quinacrine | Raises primaquine toxicity | Avoid combination — historical concern, rarely encountered in modern practice. |
| Other haemolysis-inducing drugs (dapsone, sulfonamides, nitrofurantoin in G6PD) | Additive haemolysis | Avoid combination in G6PD-deficient patients. |
| Methaemoglobin-inducing drugs (dapsone, nitrites) | Additive methaemoglobinaemia | Monitor methaemoglobin level; avoid combination. |
| Antiretrovirals (tenofovir, zidovudine, efavirenz) | No clinically significant interaction | Combination is safe. |
| CYP2D6 inhibitors (fluoxetine, paroxetine, bupropion, terbinafine) | Reduce primaquine activation → reduced efficacy + risk of P. vivax relapse | Time the antimalarial course around the antidepressant if possible; consider higher primaquine dose under specialist guidance. |
Contra-indicaties en waarschuwingen
- Absolute: severe G6PD deficiency; pregnancy (foetal G6PD status unknowable); active haemolytic anaemia; severe granulocytopenia; concurrent quinacrine.
- Strong caution: intermediate G6PD deficiency (specialist supervision needed); breastfeeding before infant G6PD test result; severe rheumatoid arthritis or systemic lupus erythematosus on bone-marrow-suppressing drugs.
- Voorzichtig: NADH cytochrome b5 reductase deficiency (methaemoglobinaemia risk); CYP2D6 poor metaboliser status (reduced efficacy).
Opslag
Store below 25 °C in a dry place, in original packaging. Keep out of reach of children.
Veelgestelde vragen
Why do I need a G6PD test before starting Primaquine?
Primaquine causes severe acute haemolytic anaemia in G6PD-deficient patients. The fluorescent spot test or quantitative G6PD activity assay are widely available and inexpensive. Test before starting; do not start primaquine on the assumption that G6PD status is normal.
What is a hypnozoite and why does it matter?
P. vivax and P. ovale parasites can persist as dormant liver-stage forms (hypnozoites) for weeks to months after the initial bite. Standard blood-stage antimalarials (chloroquine, ACTs) do not kill hypnozoites. Without primaquine radical cure, the parasite reactivates and a fresh symptomatic infection emerges weeks to months later. Primaquine is the only widely-stocked drug that kills hypnozoites.
Why a 14-day course?
Hypnozoites are biologically resistant compared to blood-stage parasites. Shorter courses (3–7 days) have unacceptably high relapse rates. The 14-day course is the WHO-recommended minimum. Longer courses (21 days) are sometimes used for tropical “Chesson-like” P. vivax strains (Oceania, Southeast Asia, parts of India) which are particularly relapse-prone.
Can Primaquine be used during pregnancy?
No. Primaquine is contraindicated in pregnancy because foetal G6PD status cannot be tested in utero. Defer radical cure until after delivery + lactation has ended. Suppress relapses with weekly chloroquine prophylaxis (in chloroquine-sensitive areas) until radical cure can be given.
What about breastfeeding?
Compatible if both mother and infant are confirmed G6PD-normal. Defer until infant G6PD status is known.
Why is primaquine sometimes given with chloroquine?
Chloroquine clears the symptomatic blood stage; primaquine clears the dormant liver stage. Together they provide both immediate symptom relief and radical cure. Don’t skip either.
Wat als ik een dosis vergeet?
Take it as soon as you remember unless it is close to the next dose. Adherence to all 14 days matters — relapse rates climb sharply with missed doses.
Does Primaquine work for P. falciparum?
Yes for transmission-blocking — a single low dose (0.25 mg/kg) with ACT clears P. falciparum gametocytes from the blood and prevents onward transmission. Not used for P. falciparum treatment in the conventional sense — that role is filled by ACTs.
What is “radical cure” vs “treatment”?
Treatment = clear the symptomatic blood-stage infection (chloroquine, ACT). Radical cure = also clear the dormant liver-stage hypnozoites in P. vivax / P. ovale to prevent relapse (primaquine, or the newer tafenoquine).
Can I take Primaquine with alcohol?
Moderate alcohol is acceptable. Heavy drinking can amplify GI upset and the small risk of hepatic toxicity. Avoid binge drinking during the 14-day course.
Why is dose specified in “base”?
Primaquine phosphate is the salt form (more stable). Doses in clinical references are quoted in primaquine base. The standard 15 mg tablet is labelled “15 mg base” — the actual phosphate salt content per tablet is ~ 26 mg. Always confirm by reading “base” or “phosphate” on dose calculations.
Other Malaria Tablets
- Lariago 250 mg — Chloroquine — kills blood-stage parasites; primaquine is then needed for liver-stage radical cure
- Mefque 250 mg — Mefloquine — once-weekly chemoprophylaxis for chloroquine-resistant areas
- Cendox 100 mg — Doxycycline — daily prophylaxis for resistant areas + radical-cure adjunct
- HCQS 200/400 mg — Hydroxychloroquine — antimalarial + autoimmune indications
- Quinin 300 mg — Quinine — selected use for chloroquine-resistant P. falciparum
More options in Malaria Tablets
Gerangschikt op recente bestelvolumes van MedsBase — wat andere klanten in deze categorie kiezen.
| Sterkte | 15 mg |
|---|---|
| Hoeveelheid | 30 Tabletten, 60 Tabletten, 90 Tabletten, 180 Tabletten |
Primaquine
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