Publication: Primaquine: the risks and the benefits
Issued Date
2014
Resource Type
Language
eng
Rights
Mahidol University
Rights Holder(s)
BioMed Central
Bibliographic Citation
Malaria Journal. Vol.13, (2014), 418
Suggested Citation
Ashley, Elizabeth A, Judith Recht, White, Nicholas J Primaquine: the risks and the benefits. Malaria Journal. Vol.13, (2014), 418. Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/2900
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
Primaquine: the risks and the benefits
Author(s)
Abstract
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.