Joseph Vinetz, M.D.; Paul A. Pham, Pharm.D.
Available formulation in Zambia: sulfadoxine-pyrimethamine tablet: 500 mg + 25 mg.
- No longer recommended for the treatment of malaria in South Africa.
Amodiaquine + sulfadoxine-pyrimethamine may be considered as an interim option in situations where Artemisinin-based combination therapy (ACTs) cannot be made available.
Zambia Information Author: Paul A. Pham, Pharm. D.
- Prophylaxis and treatment of chloroquine-resistant malaria.
- Malaria (acute) in combination with sulfadoxine and quinine in the treatment of chloroquine -resistant Plasmodium falciparum malaria. Resistance prevalent worldwide (not recommended as a prophylactic agent for travelers to most areas).
Pyrimethamine 25 mg + sulfadoxine 500 mg
*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 uncomplicated malaria (in combination with quinine): 2-3 tablets PO as a single dose given on the last day of quinine (650 mg q8h x3-7 d).
- Generally not used for prophylaxis due to the relatively frequent occurrence of side effects such as rash. Resistance has developed to these drugs, particularly in Africa and Southeast Asia.
- Malaria prophylaxis: 1 tablet PO once a week 1 or 2 days before entering the endemic area and continued during the time of residence, and then for 4 to 6 weeks after leaving the area.
No data: Sulfadoxine likely to be removed (may need to supplement).
No data: 47% of pyrimethamine is excreted by PD (may need to supplement).
- Folic acid deficiency w/ megaloblastic anemia and pancytopenia, hemolytic anemia, leukopenia, thrombocytopenia
- Allergic reaction
- Transaminase elevations
- GI intolerance: nausea, anorexia, vomiting
- Severe cutaneous (e.g., Stevens Johnson, TEN)
- Agranulocytosis, aplastic anemia, eosinophilia, hemolytic anemia (w/ G6PD deficiency), thrombocytepenic purpura.
- Interstitial nephritis and crystalluria
- Hypersensitivity pneumonititis
- Polyarteritis nodosa
Resistance common, can be detected by PCR methods. Less effective against P. vivax than P. falciparum.
- Bone marrow suppressants (e.g., interferon, trimethoprim, zidovudine, and ganciclovir): may result in additive bone marrow suppression. Use with caution.
- Aminobenzoic acid, benzocaine, procaine, tetracaine: potential sulfonamide antagonism. Avoid co-administration.
- Aurothioglucose: may increase risk of blood dyscrasias.
- Lorazepam: may increase the risk of hepatotoxicity.
Fansidar is no longer the agent of choice for malaria prophylaxis due to the risk of severe cutaneous reactions (EM, TEN, and Stevens-Johnsons syndrome). However, for the treatment of uncomplicated malaria, Fansidar is recommended as a single dose (3tabs on the last day of quinine therapy) to prevent recrudescence 3-4 weeks later. Inexpensive and often used in Africa.