pyrimethamine

Generic Daraprim

Used for Malaria

Pyrimethamine (Daraprim) is used to treat toxoplasmosis, an infection caused by a parasite. You have to take it with two additional medications: one to help fight the infection and another to lower the side effects from pyrimethamine (Daraprim). In addition, you have to get pyrimethamine (Daraprim) from a special pharmacy, and it's very expensive.

Reviewed by:

Dalga Surofchy, PharmD, APh

Cydnee Ng, PharmD

Last reviewed on July 14, 2021

What is Pyrimethamine (Daraprim)?

What is Pyrimethamine (Daraprim) used for?

Toxoplasmosis

How Pyrimethamine (Daraprim) works

Pyrimethamine (Daraprim) is an antiparasitic agent. It kills parasites by blocking folic acid, a nutrient that parasites need to live and grow.

Drug facts

Common Brands	Daraprim
Drug Class	Antiparasitic agent
Controlled Substance Classification	Not a controlled medication
Generic Status	No lower-cost generic available
Availability	Prescription only

Common Brands

Daraprim

Drug Class

Antiparasitic agent

Controlled Substance Classification

Not a controlled medication

Generic Status

No lower-cost generic available

Availability

Prescription only

Side effects of Pyrimethamine (Daraprim)

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Loss of appetite
Vomiting

Less Common Side Effects

Anemia (low red blood cell count)
Getting sick often
Bleeding more easily
Changes or swelling to tongue
Blood in urine
Changes to heart rhythm

Pyrimethamine (Daraprim) serious side effects

Contact your healthcare provider immediately if you experience any of the following.

Allergic reaction

Source: DailyMed

The following Pyrimethamine (Daraprim) side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Rare

Chest pain

dry cough

fever

rapid or trouble breathing

skin rash

unusual tiredness or weakness

Incidence not known

Black, tarry stools

bleeding gums

blistering, peeling, or loosening of the skin

blood in the urine or stools

chills

cough

diarrhea

difficulty swallowing

dizziness

fainting spells

fast or irregular heartbeat

hives, itching

irritation or soreness of the tongue

joint or muscle pain

lower back or side pain

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

painful or difficult urination

pale skin

pinpoint red spots on the skin

red, irritated eyes

red skin lesions, often with a purple center

sore throat

sores, ulcers, or white spots on the lips or in the mouth

swollen glands

tightness in the chest

unusual bleeding or bruising

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known

Loss of appetite

vomiting

weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Pros and cons of Pyrimethamine (Daraprim)

Pros

Doses can be adjusted if you experience side effects.
Okay to use in people with liver or kidney problems

Cons

Taken with two other medications to avoid side effects and to fight the infection
Must use a special pharmacy to get the prescription filled
Although there is a generic, the price is very expensive.

Pharmacist tips for Pyrimethamine (Daraprim)

Pyrimethamine (Daraprim) can be taken with food to lessen stomach upset and vomiting.
Continue taking pyrimethamine (Daraprim) for the entire therapy, even if you are feeling better.
You might require a lower dose of pyrimethamine (Daraprim) if you start to feel extremely tired, bleed more easily, or get sick very often. Talk with your healthcare provider if you experience any of these side effects.
It's recommended that you take leucovorin and another antibiotic with pyrimethamine (Daraprim). Leucovorin helps prevent serious blood problems, and the other antibiotic makes sure your infection goes away.

Common questions about Pyrimethamine

No, Pyrimethamine is only available through a special program that delivers your medication to you. Your healthcare provider will set this up for you if they prescribe Pyrimethamine.

You must take Pyrimethamine with a sulfonamide medication and leucovorin. This is because Pyrimethamine stops parasites from being able to make folic acid, an important nutrient for our living cells and bodies. The medication also affects our own folic acid production, so you have to take leucovorin (a medication similar to folic acid) to lessen this effect on our bodies.

Although there is a generic version of Pyrimethamine, the price of the medication was raised overnight from about $13.50 per tablet to about $750 per tablet in a major drug controversy in 2015.

Anyone who comes into contact with the Toxoplasma gondii parasite can get toxoplasmosis. Some possible sources include undercooked meat, cat litter (some cats can have the parasite in their stool), or reception of a contaminated organ during transplant.

Talk to your healthcare provider if you are pregnant or plan on becoming pregnant. You'll need to discuss the risks and benefits of taking the medication while pregnant, since birth defects were seen in some animal studies.

Risks and warnings for Pyrimethamine (Daraprim)

Pyrimethamine (Daraprim) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Changes to red blood cells, white blood cells, and platelets

Pyrimethamine (Daraprim) can cause changes to the blood cells in your body, which can cause a wide range of problems. Symptoms of anemia (low red blood cells) include tiredness, weakness, pale skin, irregular heartbeats, shortness of breath, and dizziness. Let your provider know if you experience any of these symptoms, if you get sick more often (low white blood cells), or if you bleed more easily (low platelets). Your provider might lower your dose of pyrimethamine (Daraprim) to help with these side effects. Your healthcare provider will also check your blood levels frequently while you take this medication to make sure your blood cell counts are within normal range.

Low folic acid

Risk factors: History of liver or kidney damage | Conditions that cause low folic acid levels | Taking phenytoin (Dilantin)

Pyrimethamine (Daraprim) can cause the folic acid levels in your body to drop. Low folic acid can lead to anemia (low red blood cell count). Your risk is higher if you have any conditions that cause low folic acid, such as problems with absorption, alcoholism, pregnancy. Let your provider know if you experience any symptoms of anemia (mentioned above).

Seizures

Risk factors: History of seizures | Taking more than 300 mg of pyrimethamine (Daraprim)

Pyrimethamine (Daraprim) can cause seizures at doses 300 mg or higher. If you have a history of convulsions or seizures, your provider might prescribe a lower starting dose of pyrimethamine (Daraprim) to help prevent more seizures from happening while you're taking the medication. Let your provider know if you've had seizures in the past.

Severe allergic reaction(s)

If you notice a sore throat, blood spots on the skin, skin paleness, trouble breathing, rash, extreme itching, or swelling of the tongue, lips or neck, stop taking pyrimethamine (Daraprim) right away and call your healthcare provider. These can be signs of a life-threatening allergic reaction to the medication.

Pyrimethamine (Daraprim) dosage

Typical dosage for Pyrimethamine (Daraprim)

The typical starting dose for adults is 50 mg to 75 mg by mouth per day for 1 to 3 weeks. After 3 weeks, the dose will be lowered by 50% and continued for another 4 to 5 weeks. This medication must be taken together with a sulfonamide medication (e.g., sulfadiazine) and leucovorin.

Interactions between Pyrimethamine (Daraprim) and other drugs

Pyrimethamine (Daraprim) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Pyrimethamine (Daraprim). Please note that only the generic name of each medication is listed below.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Aurothioglucose

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.