Primaquine (Oral)

Primaquine is prescribed for the treatment and prevention of Malaria in children and adults.

Overview

Primaquine tablets are indicated for the treatment and prevention of malaria, a serious infection transmitted by mosquito bites.

Some regions of the world are more predisposed to malaria outbreaks. This is mainly due to subtropical temperatures, which offer a perfect breeding ground for mosquito populations to flourish. Examples include:

  • Central America
  • Hispaniola
  • India
  • Oceania
  • South America
  • Southeastern Regions of Asia
  • Sub-Saharan Africa
  • The Middle East

Malaria may be endemic to these regions, but it can spread elsewhere. For example, the Center for Disease Control and Prevention records some 1,700 cases of malaria in the United States every year. Most of these cases, however, resulted from trips to Sub-Saharan Africa and Southeast Asia.

About Malaria

Malaria is a serious and potentially fatal condition that requires quick medical intervention. Some of the main telltale signs of the disease are spikes in temperature, chills, and symptoms that resemble the flu. When the disease is not treated, the chances of developing complications significantly increase. Such complications and fatalities are more common in children and seniors.

In 2016, there were more than 216 million cases of Malaria recorded worldwide, and of these numbers, more than 400,000 succumbed to complications of the disease.

The disease is transmitted via mosquito bites carrying malaria parasites. These dangerous organisms go on to make a home in red blood cells, tissues, and even the liver.

Primaquine is widely considered to be an effective treatment for malaria. It may be prescribed alone or in conjunction with other medicines, including chloroquine. Primaquine is currently included in the List of Essential Medicines, which is posted and reviewed by the World Health Organization (WHO). It is usually well tolerated by patients of all ages.

Top Indications for Use

According to the CDC, primaquine is predominantly prescribed to patients:

  • Before Traveling to High-Risk Regions
  • After Traveling to High-Risk Regions
  • Who Have Tested Positive for Malaria

Brand Names

Primaquine is available under several brand names, including but not limited to:

  • Jasoprim
  • Malirid
  • Neo-Quipenyl
  • Pimaquin
  • Primachina
  • Primacin
  • Primaquina
  • Primaquine
  • Primaquine Diphosphate
  • Primaquine Phosphate
  • Remaquin

Conditions Treated?

Type Of Medicine?

  • Antiprotozoal
  • Antimalarial Medicine

Side Effects

Primaquine may cause adverse reactions to occur. The most commonly reported include:

  • Muscle Cramps
  • Nausea
  • Upset Stomach
  • Vomiting
  • Pain in the Back and Legs
  • Appetite Loss
  • Spikes in Temperature
  • Lethargy
  • Changes in Urine Color

Rare Side Effects of Primaquine

Some potentially rare side effects of this medicine include:

  • Feeling Dizzy or Lightheaded
  • Blue Looking Skin and Nails
  • Difficulty Breathing
  • Symptoms That Mimic a Common Cold or Flu

Dosage

The dosage amounts for Primaquine are largely dependent on the patient's age. However, other factors such as the medicine's strength and length of treatment also play a role in dosage outlines. The below tables provide indicated dosages for healthcare providers. Nevertheless, it should not replace the instructions provided by your doctor:

  • Younger Children: Based on Weight
  • Older Children: 15 mg | 1x per Day | 14 Days
  • Adults: 15 mg | 1x per Day | 14 Days

How to Take

Primaquine tablets should be taken with a full meal, especially if you experience an upset stomach during the first few doses.

To adequately eliminate malaria infections, it is important to complete the full course of treatment prescribed, even if you feel better before this time. Similarly, if Primaquine is ordered as a preventative cover against possible malaria exposure, it is vital that you take the medicine as prescribed for the most efficiency.

Missed Doses

If you forget to take your medicine, take it as soon as you remember. The medicine works best when the recommended dose is followed. It is important to never double doses of Primaquine. Therefore, if the next day is quickly approaching, skip the missed dose and resume the normal schedule the following day.

Interactions

To avoid negative drug interactions with Primaquine, write a full list of all the current medications you're taking, including herbal supplements, vitamins, and other over-the-counter medicines. Your doctor will determine if Primaquine is safe to use with these or any other drugs on your list.

Drug Interactions

The following drug contraindications have been found with Primaquine:

  • Aurothioglucose
  • Levomethadyl
  • Quinacrine

Underlying Medical Conditions

Primaquine may cause some conditions to become worse or cause increased side effects in certain patients. Tell your doctor if you have these or any other pre-existing conditions before starting treatment with Primaquine:

Warnings

Follow the precautions outlined by your pharmacist or healthcare worker when starting treatment with Primaquine.

An insert label is generally included with all prescriptions. Be sure to read these instructions in full to reduce the risk of side effects. Moreover, insert labels provide tips for when it's necessary to seek emergency medical help.

Traveling

Consult a healthcare specialist if you plan on traveling abroad in the coming days or weeks. Your doctor will provide tips for keeping safe and will possibly prescribe antimalarial medicines such as Primaquine to decrease the risk of transmitting malaria.

The standard doses for travelers are:

  • 2 Days Before Traveling: 1 Pill | 1X per Day (Discuss Dosage Strength with Doctor)
  • During Travels: 1 Pill | 1X per Day (Discuss Dosage Strength with Doctor)
  • After Traveling: 1 Pill | 1X per Day (Discuss Dosage Strength with Doctor) for 7 Consecutive Days.

Note: Be sure to consult your healthcare provider for personalized dosage amounts that factor in age and weight.

Accessing the Medicine

American travelers who plan on taking a short or long trip to certain countries are advised to seek local medical help. This is because some of the medicines advertised in foreign countries may not be strictly governed for quality and safety.

Healthcare workers, therefore, strongly advise against buying Primaquine abroad.

Blood Tests

A follow-up appointment is normally scheduled to determine if Primaquine promotes blood disorders. Among the tests that are generally taken are blood cell counts and hemoglobin levels to determine if the following conditions are present:

  • Anemia
  • Methemoglobinemia
  • Leukopenia

The risk of developing these blood issues increases for patients who have exceeded the recommended dose of 15 mg per day. Be sure to keep all follow-up appointments, if applicable, when using this medicine.

Persistent Side Effects

Most side effects of Primaquine go away. If your symptoms persist, be sure to consult your healthcare provider immediately.

Use in Pregnancy

Primaquine is not indicated for use during pregnancy as the medicine may cause serious injury to developing fetuses. Inform your doctor if you are pregnant or plan to be; or if you are currently breastfeeding. Patients are advised to complete contraceptive treatments for at least one full menstrual cycle before starting Primaquine to reduce the risk of a complicated pregnancy.

Additionally, male patients whose partners may be pregnant are advised to wear a condom for at least 12 weeks post-treatment with Primaquine.

G6PD Deficiency

G6PD Deficiency is a rare genetic disorder. Many people with this condition are unaware of it until triggers like Primaquine are prescribed.

To reduce the risk of complications stemming from Primaquine, medical specialists perform a quick blood test to verify if there is a G6PD deficiency. In the event of an underlying G6PD deficiency, the condition could become worse, causing patients to become seriously ill “ and would therefore not be prescribed.

Storage

Keep primaquine in the original container at a room temperature of 25° C (77° F). Ensure the airtight seal is in effect after each use.

Never place this drug in extreme temperatures of high heat or freezing environments. Also, avoid light and areas with moisture and humidity.

Primaquine should never be stored within the reach of children or pets. In the event of an overdose, contact your local or regional poison control center.

Summary

Primaquine is an antimalarial drug used to treat and prevent malaria. It is available by prescription only and is indicated for both children and adults.

Primaquine is most commonly prescribed in regions that experience significant outbreaks of malaria on a yearly basis. A few examples include South and Central America, Sub-Saharan Africa, and Southeast Asia. It is also suggested for foreign travelers visiting high-risk areas that are renowned for malaria epidemics.

In the United States, for example, 1,700 cases of malaria were reported in 2016. Most of these transmissions were attributed to overseas travel. As a preventative measure, Primaquine may be prescribed before travels are scheduled “ up to two days in advance.

Parasitized blood is usually treated with Chloroquine first to wipe out the parasites. This medicine is used concurrently with Primaquine in most cases to prevent the relapse of malaria. Primaquine is taken by mouth for generally two weeks to effectively wipe out all traces of malaria parasites living in red blood cells and body tissues.

It is usually well tolerated by all ages, and in most cases, use with food is recommended to reduce the common side effect of an upset stomach.