Publication: Primaquine: The risks and the benefits
Issued Date
2014-11-03
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ISSN
14752875
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2-s2.0-84920774125
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Mahidol University
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SCOPUS
Bibliographic Citation
Malaria Journal. Vol.13, No.1 (2014)
Suggested Citation
Elizabeth A. Ashley, Judith Recht, Nicholas J. White Primaquine: The risks and the benefits. Malaria Journal. Vol.13, No.1 (2014). doi:10.1186/1475-2875-13-418 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/33947
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Title
Primaquine: The risks and the benefits
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Abstract
© 2014 Ashley et al.; licensee BioMed Central Ltd. 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.