Primaquine: the risks and the benefits
Primaquine is the only generally available anti-malarial that prevents relapse in vivax and ovale malaria, and the only potent gametocytocide in falciparum malaria. Primaquine becomes increasingly important as malaria-endemic countries move towards elimination, and although it is widely recommende...
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| Main Authors: | , , |
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| Other Authors: | |
| Format: | Article |
| Language: | English |
| Published: |
2017
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| Subjects: | |
| Online Access: | https://repository.li.mahidol.ac.th/handle/123456789/2900 |
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| Institution: | Mahidol University |
| Language: | English |
| Summary: | Primaquine is the only generally available anti-malarial that prevents relapse in vivax and ovale malaria, and the only
potent gametocytocide in falciparum malaria. Primaquine becomes increasingly important as malaria-endemic
countries move towards elimination, and although it is widely recommended, it is commonly not given to malaria
patients because of haemolytic toxicity in subjects who are glucose-6-phosphate dehydrogenase (G6PD) deficient
(gene frequency typically 3-30% in malaria endemic areas; >180 different genetic variants). In six decades of
primaquine use in approximately 200 million people, 14 deaths have been reported. Confining the estimate to
reports with known denominators gives an estimated mortality of one in 621,428 (upper 95% CI: one in 407,807).
All but one death followed multiple dosing to prevent vivax malaria relapse. Review of dose-response relationships
and clinical trials of primaquine in G6PD deficiency suggests that the currently recommended WHO single low dose
(0.25 mg base/kg) to block falciparum malaria transmission confers a very low risk of haemolytic toxicity. |
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