Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
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).
Zambia Information Author: Paul A. Pham, Pharm. D.
- Malaria prevention of relapses (radical cure) caused by Plasmodium vivax. Also effective against gametocytes of P. falciparum.
|Primaquine||Primaquine||Sanofi-Aventis U.S. ||oral|
26.3 mg (15 mg base)
*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.
Treatment of PCP: 15-30 mg (base) once-daily with food (in combination with clindamycin).
Usual dose; HD: no data, dose post-HD.
- Hemolytic anemia (in pts with G6-PD deficiency). Screen for G6-PD deficiency (African and Mediterranean descent).
Neutropenia and leukopenia (incidence may be higher with primaquine 30 mg).
- GI intolerance (abdominal pain, nausea, and vomiting).
Bone marrow suppressive drugs (i.e AZT, ganciclovir, pyrimethamine, flucytosine, interferon): Potential for additive bone marrow suppression with co-administration.
- Blurred vision
Pneumocystis jiroveci (formerly P. carinii), Plasmodium vivax, and P. falciparum (gametocyte form)
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.
- 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 ;
2008 ; Vol.
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.