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 Zambia HIV National Guidelines
 


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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Primaquine

Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
12-01-2010

Zambia Specific Information

  • Available formulation in Zambia: Tablet: 7.5 mg; 15 mg (as diphosphate)
  • P. ovale and P. vivax malaria: primaquine 15 mg (0.25mg/kg base) once-daily x 14 days PLUS chloroquine.
  • PCP treatment in SMX/TMP allergic pts: Clindamycin 600 mg q8h plus primaquine 15 mg once-daily x 21 days.
  • Check for G-6-PD deficiency. Avoid with severe G-6-PD deficiency (<10% residual enzyme activity), but lower doses of primaquine (0.5-0.7 mg/kg) may be used in mild G-6-PD deficiency (10-60% residual enzyme activity).

REFERENCES

Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

  • Malaria prevention of relapses (radical cure) caused by Plasmodium vivax. Also effective against gametocytes of P. falciparum.
NON-FDA APPROVED USES

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
PrimaquinePrimaquineSanofi-Aventis U.S. oral
tablet
26.3 mg (15 mg base)
$1.51

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

Treatment of PCP: 15-30 mg (base) once-daily with food (in combination with clindamycin).

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

Usual dose; HD: no data, dose post-HD.

DOSING IN HEMODIALYSIS

No data.

DOSING IN PERITONEAL DIALYSIS

No data.

DOSING IN HEMOFILTRATION

No data.

ADVERSE DRUG REACTIONS

OCCASIONAL

  • Hemolytic anemia (in pts with G6-PD deficiency). Screen for G6-PD deficiency (African and Mediterranean descent).
  • Methemoglobinemia.
  • Neutropenia and leukopenia (incidence may be higher with primaquine 30 mg).
  • GI intolerance (abdominal pain, nausea, and vomiting).
RARE

  • Blurred vision
  • Headache
  • Pruritis

DRUG INTERACTIONS

 Bone marrow suppressive drugs (i.e AZT, ganciclovir, pyrimethamine, flucytosine, interferon): Potential for additive bone marrow suppression with co-administration.

SPECTRUM

Pneumocystis jiroveci (formerly P. carinii), Plasmodium vivax, and P. falciparum (gametocyte form)

PHARMACOLOGY

Pharmacology

COMMENTS

Primaquine in combination with clindamycin is good second-line treatment for mild, moderate, and severe P. carinii in pts intolerant of TMP/SMX. Prior screening for G6-PD deficiency recommended to prevent hemolytic anemia.

Basis for Recommendations

  • National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/IDSA) ; Guidelines for Prevention and Treatment of Opportunistic Infections inHIV-Infected Adults and Adolescents ; http://AIDSinfo.nih.gov. ; 2008 ; Vol.
    Rating: Basis for recommendation
    Comments:Although primaquine/clindamycin efficacy data not as robust as data supporting IV pentamidine for treatment of severe PCP, OI treatment guidelines recommend that primaquine/clindamycin OR IV pentamidine be considered as allternatives to TMP/SMX for pts with moderate-to-severe PCP.

REFERENCES

REFERENCED WITHIN THIS GUIDE


 
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