Primaquine
Primaquine helps treat certain types of malaria. It's also commonly used for prevention of malaria if you're traveling to a region where the disease is commonly found. This medication can cause stomach upset, nausea, and diarrhea.
What is Primaquine?
What is Primaquine used for?
- Malaria caused by the Plasmodium vivax parasite
How Primaquine works
Primaquine is an antimalarial medication. Malaria is a disease that's spread to humans by a bite from a mosquito that's infected with a parasite called Plasmodium vivax. Primaquine works by interfering with certain processes that the Plasmodium vivax parasite needs to grow.
Drug facts
Side effects of Primaquine
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
- Nausea
- Vomiting
- Stomach pain or cramps
- Dizziness
Less Common Side Effects
- Changes in heart rhythm
- Changes to your blood cell counts (see Risks and Warnings)
- Rash
- Itching
Primaquine serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Low white blood cell count: getting sick more often, illness that doesn't go away
- Low red blood cell count: dark urine, tiredness, weakness, dizziness, pale skin
The following Primaquine 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:
Incidence not known
Back, leg, or stomach pains
black, tarry stools
bleeding gums
bluish-colored lips, fingernails, or palms
chills
dark urine
difficulty breathing
dizziness, faintness, or lightheadedness
fast, slow, pounding, or irregular heartbeat
general body swelling
headache
loss of appetite
nausea or vomiting
nosebleeds
painful or difficult urination
pale skin
rapid heart rate
sores, ulcers, or white spots on the lips or in the mouth
swollen glands
unusual bleeding or bruising
unusual tiredness or weakness
yellowing of the eyes or skin
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:
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.
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Pros and cons of Primaquine
Pros
- Good choice to treat certain types of malaria
- Taken only once a day
- Good for last minute travelers for malaria prevention; can start the medication 1 to 2 days before traveling
Cons
- Must be tested for a genetic condition called glucose-6-phosphate dehydrogenase (G6PD) deficiency before starting
- Can cause stomach upset
- Can't be used in pregnancy
Pharmacist tips for Primaquine
- If you're traveling, check if you need malaria prevention for your destination.
- Take Primaquine with food to help prevent any stomach pain or nausea.
- If you're taking Primaquine to prevent malaria, make sure you start the medication 1 to 2 days before you arrive at your destination, take it once a day at your travel location, and continue it for 7 days after you've left.
- Don't take any more tablets of Primaquine than prescribed or for longer than prescribed, as this can raise your risk of serious side effects, like abnormal blood cell counts.
- Use birth control that works well for you while taking Primaquine. It's important to avoid becoming pregnant while taking this medication, because it might be harmful to your unborn baby. Talk to your healthcare provider about birth control methods that are right for you.
- To prevent mosquito bites while you travel, use insect repellent (such as DEET), wear long-sleeved shirts and pants, use mosquito netting, and use air conditioning, if available.
Common questions about Primaquine
Yes. While Primaquine is FDA-approved only to treat malaria, the CDC also recommends this medication as an option to prevent malaria if you're visiting certain countries. Check to see if it's recommended to take antimalarial medication for prevention for your travel destination.
For prevention of malaria in adults, the CDC recommends taking 2 tablets of Primaquine by mouth once a day starting 1 to 2 days before you travel, during the days while traveling in the area with malaria risk, and continuing for 7 days after you return. If you're going on a long trip, you might need to continue taking the medication for 2 weeks after returning. For children, the dose is based on your child's body weight following the same schedule. Talk to your child's provider for dosing.
For the treatment of malaria, the CDC-recommended dose is 2 tablets of Primaquine by mouth once daily for 14 days, while the standard dose is 1 tablet once daily for 14 days. There are concerns that the standard dose might not be strong enough to treat malaria. So taking a higher dose of Primaquine might help the medication be more successful in treating malaria.
It's recommended to take Primaquine with food to lower the chance of an upset stomach. If you vomit (throw up) within 30 minutes of taking the medication, you can repeat the dose again.
No, don't take Primaquine if you're pregnant. While there haven't been any studies about the safety of Primaquine in pregnant humans, the medication can cause harm to unborn animals. To be safe, use a form of birth control that works well for you while taking this medication to prevent getting pregnant. Talk to your healthcare provider if you're pregnant or planning to become pregnant and you're prescribed Primaquine.
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Risks and warnings for Primaquine
Primaquine 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 cell counts in people with G6PD deficiency
Before taking Primaquine, your healthcare provider might test you for a genetic condition called glucose-6-phosphate dehydrogenase (G6PD) deficiency. People with G6PD deficiency who take Primaquine have a higher risk of low red blood cell counts (hemolytic anemia). This is when your red blood cells get destroyed faster than your body is able to make new ones. Discuss the risks and benefits of taking this medication if you have G6PD deficiency. You might be able to take Primaquine with close monitoring of your blood cell counts through regular blood work. Don't take Primaquine if you have severe G6PD deficiency. Stop the medication and let your provider know right away if you experience dark urine, tiredness, weakness, dizziness, or pale skin, as these can be signs of hemolytic anemia.
Blood problems
- Risk factors: Personal or family history of hemolytic anemia or nicotinamide adenine dinucleotide (NADH) methemoglobin reductase deficiency | Taking Primaquine for a long time
Primaquine can cause blood problems, including a low white blood cell count, low red blood cell count, and destruction of red blood cells. This risk is higher if you have a personal or family history of blood problems, a certain genetic condition called NADH methemoglobin reductase deficiency, or take Primaquine for a long period of time. Before you take this medication, let your healthcare provider know your full medical history. Don't take Primaquine longer than prescribed. Your healthcare provider might check your blood levels every so often while you're taking this medication to make sure they're within normal range. Let your provider know if you're getting sick more often (sign of a low white blood cell count) or experiencing dark urine, tiredness, weakness, dizziness, or pale skin (signs of hemolytic anemia).
Heart rhythm problems
- Risk factors: History of heart disease or heart rhythm problems | Electrolyte problems | Taking medications that can cause QT prolongation
Primaquine can cause a heart rhythm problem known as QT prolongation (changes in the beats and electrical signals of your heart). The risk is higher if you have certain heart problems or take other medications that can also cause this heart rhythm problem. Let your healthcare provider know about your full medical history and all the medications you're taking, including over-the-counter medications and supplements, so they can make sure Primaquine is safe for you to take. Tell your provider if you experience an abnormal heartbeat while taking this medication.
Primaquine dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 26.3mg | 28 tablets | $25.10 | $0.90 |
Typical dosage for Primaquine
Note: This medication comes in 26.3 mg salt tablets, which is the same as 15 mg of the active ingredient (primaquine).
Treatment of malaria: The typical standard dose is 1 tablet by mouth once daily for 14 days. The medication is normally taken at the same time as chloroquine, another antimalarial medication.
- The Centers for Disease Control and Prevention (CDC) recommends 2 tablets once daily for 14 days. Please see FAQs for more information on why the CDC-recommended dose is different than the standard dose.
Prevention of malaria: Primaquine is not FDA-approved for this purpose. Please see FAQs for more information on CDC recommendations and dosing for this "off-label" use.
Interactions between Primaquine and other drugs
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
- Levomethadyl
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.
How much does Primaquine cost?
$25.10
Primaquine contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Primaquine will not be safe for you to take.
- Severe G6PD deficiency
- Currently pregnant
- Serious illness from conditions that tend to cause low white blood cells (e.g., rheumatoid arthritis, lupus)
- Take medications that lower blood cell counts
- Take quinacrine
What are alternatives to Primaquine?
Note: When used for the treatment of malaria caused by Plasmodium vivax, you will need to combine mefloquine with another antimalarial medication called primaquine.
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