Krintafel
Tafenoquine is a malaria medication. It's only available as 2 different brand-name medications: Arakoda to prevent malaria in adults and Krintafel to treat malaria for people age 16 years and older. Before you can start tafenoquine, your provider will order lab work to make sure you don't have a genetic blood condition that raises your risk for hemolytic anemia, a serious blood condition. Some side effects of tafenoquine include dizziness, headache, and nausea.
What is Tafenoquine?
What is Tafenoquine used for?
How Tafenoquine works
Tafenoquine is an antimalarial medication. It kills the parasites that cause malaria by disturbing certain processes that the parasites need to grow.
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What are the side effects of Tafenoquine?
Common Side Effects
- Headache (15-32%)
- Diarrhea (5-18%)
- Back pain (14%)
- Nausea (5-7%)
- Motion sickness (5%)
- Vomiting (2-5%)
- Dizziness (1-5%)
- Dizziness (8%)
- Nausea (6%)
- Vomiting (6%)
- Headache (5%)
- Anemia (low red blood cells) (5%)
Other Side Effects
- Liver damage
- Trouble sleeping
- Abnormal dreams
- Depression
- Anxiety
Serious Side Effects
- Blood problems (methemoglobinemia): seizures, loss of consciousness, heart rhythm problems such as heart racing, dizziness, shortness of breath, bluish lips
- Suicidal thoughts and behavior
- Severe allergic reaction: swelling of the throat, lips, tongue, or face, trouble breathing, hives
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Headache, unusual weakness or fatigue, shortness of breath, nausea, vomiting, rapid heartbeat, blue skin or lips, which may be signs of methemoglobinemia
- Hemolytic anemia—unusual weakness or fatigue, dizziness, headache, trouble breathing, dark urine, yellowing skin or eyes
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Tafenoquine
Pros
Only need to start Arakoda (tafenoquine) 3 days before travel, good for last minute travels
Only need to take Arakoda (tafenoquine) weekly while staying in area with malaria
Can be used as malaria prevention in most countries (Arakoda)
Only need to take Krintafel (tafenoquine) as a one-time dose for malaria treatment, in addition to chloroquine
Cons
Need to take with food
Available as brand-name medications only
Not recommended during pregnancy or breastfeeding
Need to get a blood test to check for G6PD deficiency first, which can be inconvenient
Pharmacist tips for Tafenoquine
Before you start taking tafenoquine, your provider will need to test you for a genetic disorder called G6PD deficiency. People who have G6PD deficiency and take tafenoquine could develop a condition called hemolytic anemia. If you experience darker lips or urine, dizziness, headache, light-headedness, shortness of breath, or confusion, get medical help and let your provider know right away.
Make sure your prescription for tafenoquine is correct before you leave the pharmacy. Arakoda is used to prevent malaria. Krintafel is used to treat malaria.
Swallow the tablets whole. Don't break, crush, or chew them. Take tafenoquine with food so that you can better absorb the medication.
If you're taking Arakoda, make sure to complete the entire course before, during, and after your travels. Stopping it too soon will put you at higher risk for malaria infection. It can be helpful to use a calendar to keep track of which days and dose you're on.
If you're taking Krintafel to treat malaria and vomit within 1 hour after your dose, you can take another dose. If you vomit again, don't take another dose.
Krintafel won't work well to treat malaria on its own. It must be taken with chloroquine, either on the first or second day you start chloroquine.
Let your provider know all of the medications you're taking, since tafenoquine can change the way certain medications work in your body and lead to side effects (e.g., metformin (Glucophage)).
Tafenoquine isn't recommended during pregnancy. Avoid pregnancy and use contraception (birth control) during treatment and for 3 months after your last dose of tafenoquine, since it can cause harm to you and your unborn baby during pregnancy.
Breastfeeding isn't recommended during and for 3 months after your last dose of tafenoquine. There isn't enough information to fully understand how this medication will affect a breastfed baby. But if your baby has G6PD deficiency, this medication can put them at risk for hemolytic anemia. Talk with your provider about your options for malaria treatment or prevention if you're breastfeeding.
Get medical help right away if you experience hallucinations (seeing or hearing things that aren't there), strange thoughts, or if you get confused while taking tafenoquine.
Frequently asked questions about Tafenoquine
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What are the risks and warnings for Tafenoquine?
Tafenoquine 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.
Low red blood cells
Risk factors: G6PD deficiency
Tafenoquine can cause dangerously low red blood cells (hemolytic anemia) in people who have a genetic condition called G6PD deficiency. Before starting tafenoquine, your provider will test you for G6PD deficiency. If you're able to become pregnant, your provider might ask you to take a pregnancy test before starting tafenoquine. This medication isn't recommended in pregnancy or breastfeeding because even if your G6PD level is normal, but you're pregnant with or breastfeeding a baby that has G6PD deficiency, this medication can cause harm to your baby. You're recommended to use effective birth control and pause breastfeeding during treatment with and for 3 months after your last dose of tafenoquine. Get medical help right away if you experience symptoms of hemolytic anemia, such as tiredness, shortness of breath, fast heartbeat, dark urine, or a fever while taking tafenoquine,
Methemoglobinemia (a blood condition)
Risk factors: Family history of methemoglobinemia | G6PD deficiency
A serious blood condition called methemoglobinemia has been reported when using tafenoquine. When your body makes too much of a protein called methemoglobin, your red blood cells deliver less oxygen to different parts of your body. This can cause serious side effects like blue or gray skin color, seizures, coma, changes in heart rate or rhythm, and death. Your risk is higher if you have G6PD deficiency or a family history of methemoglobinemia caused by a genetic condition. Get medical help as soon as possible if you experience pale, blue, or gray skin color, headache, fast heart rate, shortness of breath, or lightheadedness, as these can be early signs of this blood condition.
Extreme changes in mood, thoughts, or behavior
Risk factors: History of mental health conditions
Tafenoquine can cause mental health symptoms, such as anxiety, abnormal dreams, trouble sleeping, depression, and psychosis. Your risk is higher if you have a history of mental health conditions. Don't take Arakoda if you're currently experiencing or have a history of psychosis. Some people might not notice these side effects until many weeks after starting tafenoquine. Make sure to discuss your medical history with your provider before taking tafenoquine, and let your provider know right away if you notice symptoms such as any changes in your mood, start to see or hear things that aren't there, start to have nightmares, or trouble sleeping.
Risk of malaria coming back (Krintafel)
Risk factors: Taking Krintafel with other malaria medications besides chloroquine
Krintafel is only approved to be taken with chloroquine. You must start Krintafel on the first or second day you start chloroquine. If you take Krintafel with any other malaria medication, it won't work as well and you'll have a higher risk of malaria coming back.
Tafenoquine dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 150mg | 16 tablets | $259.30 | $16.21 |
Typical dosing for Tafenoquine
Malaria prevention (Arakoda)
Starting 3 days before traveling to an area with malaria: Take 200 mg by mouth once daily with food for 3 days.
After you've arrived at your destination: Take 200 mg by mouth once weekly with food as your maintenance dose (starting 7 days after your last starting dose).
Once you've left the area with malaria: Take 200 mg by mouth one time with food (7 days after your last maintenance dose).
Arakoda can be taken for up to 6 months at a time.
Malaria treatment (Krintafel)
The typical dose is 300 mg by mouth one time with food. Take it together with chloroquine, on the first or second day of starting chloroquine.
How much does Tafenoquine cost?
Tafenoquine contraindications
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
During breastfeeding if baby has G6PD deficiency (or if unclear whether baby has this condition)
History of psychotic disorder or psychotic symptoms (Arakoda)
What are alternatives to Tafenoquine?
Treatment of uncomplicated malaria
Prevention of malaria in areas of the world where there's no tafenoquine resistance
Extraintestinal amebiasis (a type of parasitic infection)
Prevention and treatment of malaria caused by Plasmodium falciparum species
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References
Best studies we found60 Degrees Pharmaceuticals, LLC. (2023). Arakoda- tafenoquine tablet, film coated [package insert]. DailyMed.
Centers for Disease Control and Prevention. (2021). Malaria information and prophylaxis, by country [A].
Centers for Disease Control and Prevention. (2023). Choosing a drug to prevent malaria.
GlaxoSmithKline LLC. (2023). Krintafel- tafenoquine succinate tablet, film coated [package insert]. DailyMed.
MedlinePlus. (2015). Autosomal recessive congenital methemoglobinemia.
MedlinePlus. (2022). Methemoglobinemia.
MedlinePlus. (2023). Glucose-6-phosphate dehydrogenase deficiency.
National Heart, Lung, and Blood Institute. (2022). Hemolytic anemia.
National Institute of Mental Health. (n.d.). Understanding psychosis.
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