Dosing & Uses
Dosage Forms & Strengths
tablet
- 26.3mg
Prevention of relapse of P. vivax malaria
30 mg PO qDay for 14 days
Uncomplicated P. vivax and P. ovale malaria (off-label)
30 mg PO qDay for 14 days with chloroquine or hydroxychloroquine
Alternatively, for mild G6PD deficiency or as an alternative to daily regimen: 45 mg PO qWeek for 8 weeks (use only after consultation with an infectious disease/tropical medicine expert) (CDC 2013)
See also Dosing Considerations
Chemoprophylaxis (Off-label)
P. vivax and P. ovale maleria: 30 mg PO qDay for 14 days after departure from malaria-endemic area
P. Jiroveci Pneumonia (Orphan)
For use in combination with clindamycin in the treatment of P. Jiroveci pneumonia associated with AIDS
15-30 mg base PO qD for 21 days (with clindamycin IV or PO)
Orphan indication sponsor
- Sanofi Winthrop, Inc; 90 Park Avenue; New York, NY 10016
Dosing Considerations
Monitor: CBC
Because primaquine can cause hemolytic anemia in G6PD-deficient persons, G6PD screening must occur prior to starting treatment with primaquine
Dosage Forms & Strengths
tablet
- 26.3mg
Uncomplicated P. vivax and P. ovale malaria (Off-label)
0.5 mg/kg (30 mg/day maximum) qDay for 14 days with chloroquine or hydroxychloroquine
Chemoprophylaxis
0.5 mg/kg PO qDay (30 mg/day maximum); start 1-2 days prior to travel and continue for 7 days after departure from malaria endemic area
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (3)
- dronedarone
primaquine and dronedarone both increase QTc interval. Contraindicated.
- lefamulin
lefamulin will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.
- thioridazine
primaquine and thioridazine both increase QTc interval. Contraindicated.
Serious - Use Alternative (95)
- amiodarone
primaquine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
- amisulpride
amisulpride and primaquine both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
- anagrelide
primaquine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- apalutamide
apalutamide will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
- arsenic trioxide
primaquine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine
primaquine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine transdermal
asenapine transdermal and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- azithromycin
primaquine and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.
- bedaquiline
primaquine and bedaquiline both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine
primaquine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine transdermal
buprenorphine transdermal and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- carbamazepine
carbamazepine will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ceritinib
ceritinib and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- chloroquine
chloroquine and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- chlorpromazine
primaquine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.
- citalopram
citalopram and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- clarithromycin
clarithromycin will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
clarithromycin and primaquine both increase QTc interval. Avoid or Use Alternate Drug. - crizotinib
crizotinib and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- dapsone topical
primaquine, dapsone topical. unspecified interaction mechanism. Avoid or Use Alternate Drug. Avoid coadministration of dapsone topical with oral dapsone or antimalarial medications because of the potential for hemolytic reactions.
- deferiprone
deferiprone, primaquine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- desflurane
desflurane and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- disopyramide
primaquine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- dofetilide
primaquine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- doxepin
doxepin and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- droperidol
primaquine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- entrectinib
primaquine and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
- enzalutamide
enzalutamide will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- eribulin
eribulin and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin base
primaquine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin ethylsuccinate
primaquine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin lactobionate
primaquine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin stearate
primaquine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
- fexinidazole
fexinidazole and primaquine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
fexinidazole will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates. - formoterol
primaquine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
- fosphenytoin
fosphenytoin will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- glasdegib
primaquine and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.
- grapefruit
grapefruit will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- hydroxychloroquine sulfate
primaquine and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- ibutilide
primaquine and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.
- idelalisib
idelalisib will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
- iloperidone
primaquine and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.
- inotuzumab
primaquine and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.
- isoflurane
isoflurane and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
ivosidenib will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
primaquine and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug. - lefamulin
primaquine and lefamulin both increase QTc interval. Avoid or Use Alternate Drug.
- lenvatinib
primaquine and lenvatinib both increase QTc interval. Avoid or Use Alternate Drug.
- lofexidine
primaquine and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.
- lonafarnib
primaquine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to or continue lonafarnib at starting dose. During coadministration, closely monitor for arrhythmias and events (eg, syncope, heart palpitations).
- lopinavir
primaquine and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.
- macimorelin
primaquine and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.
- methadone
primaquine and methadone both increase QTc interval. Avoid or Use Alternate Drug.
- midostaurin
primaquine and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.
- mifepristone
mifepristone will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
primaquine and mifepristone both increase QTc interval. Avoid or Use Alternate Drug. - mobocertinib
primaquine and mobocertinib both increase QTc interval. Avoid or Use Alternate Drug.
- moxifloxacin
primaquine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- nilotinib
primaquine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
- ondansetron
primaquine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.
- osimertinib
primaquine and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.
- oxaliplatin
oxaliplatin and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
primaquine and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug. - ozanimod
primaquine and ozanimod both increase QTc interval. Avoid or Use Alternate Drug.
- paliperidone
primaquine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- pazopanib
primaquine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.
- pentamidine
primaquine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- pimavanserin
primaquine and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.
- pimozide
primaquine and pimozide both increase QTc interval. Contraindicated.
- pitolisant
primaquine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.
- ponesimod
primaquine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.
- primidone
primidone will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- procainamide
primaquine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- propafenone
primaquine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- quetiapine
primaquine and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.
- quinacrine
quinacrine increases levels of primaquine by unspecified interaction mechanism. Avoid or Use Alternate Drug.
- quinidine
primaquine and quinidine both increase QTc interval. Avoid or Use Alternate Drug.
- quinine
primaquine and quinine both increase QTc interval. Avoid or Use Alternate Drug.
- ribociclib
primaquine and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.
- rifampin
rifampin will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ropeginterferon alfa 2b
ropeginterferon alfa 2b, primaquine. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.
- saquinavir
primaquine and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.
- selpercatinib
primaquine and selpercatinib both increase QTc interval. Avoid or Use Alternate Drug.
- sevoflurane
sevoflurane and primaquine both increase QTc interval. Avoid or Use Alternate Drug.
- siponimod
primaquine and siponimod both increase QTc interval. Avoid or Use Alternate Drug.
- sorafenib
primaquine and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.
- sotalol
primaquine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.
- stiripentol
primaquine will decrease the level or effect of stiripentol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration of stiripentol with strong CYP3A4 inducers, increase stiripentol dose.
- toremifene
primaquine and toremifene both increase QTc interval. Avoid or Use Alternate Drug.
- trazodone
primaquine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
- tucatinib
tucatinib will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.
- vandetanib
primaquine and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.
- vemurafenib
primaquine and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.
- voxelotor
voxelotor will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.
- ziprasidone
primaquine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (106)
- acalabrutinib
acalabrutinib, primaquine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.
- albuterol
albuterol and primaquine both increase QTc interval. Use Caution/Monitor.
- alfuzosin
alfuzosin and primaquine both increase QTc interval. Use Caution/Monitor.
- apomorphine
apomorphine and primaquine both increase QTc interval. Use Caution/Monitor.
- arformoterol
arformoterol and primaquine both increase QTc interval. Use Caution/Monitor.
- aripiprazole
aripiprazole and primaquine both increase QTc interval. Use Caution/Monitor.
- artemether
artemether and primaquine both increase QTc interval. Use Caution/Monitor.
- artemether/lumefantrine
artemether/lumefantrine and primaquine both increase QTc interval. Use Caution/Monitor.
- atogepant
primaquine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- atomoxetine
atomoxetine and primaquine both increase QTc interval. Use Caution/Monitor.
- avapritinib
primaquine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- axitinib
primaquine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- bosentan
bosentan will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- bupivacaine implant
primaquine, bupivacaine implant. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.
- cenobamate
cenobamate will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
- ciprofloxacin
primaquine and ciprofloxacin both increase QTc interval. Use Caution/Monitor.
- clozapine
clozapine and primaquine both increase QTc interval. Use Caution/Monitor.
- crofelemer
crofelemer increases levels of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.
- dabrafenib
dabrafenib will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- darunavir
darunavir will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- dasatinib
dasatinib and primaquine both increase QTc interval. Use Caution/Monitor.
- degarelix
degarelix and primaquine both increase QTc interval. Use Caution/Monitor.
- deutetrabenazine
deutetrabenazine and primaquine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- dolasetron
dolasetron and primaquine both increase QTc interval. Use Caution/Monitor.
- donepezil
donepezil and primaquine both increase QTc interval. Use Caution/Monitor.
- efavirenz
efavirenz will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
efavirenz and primaquine both increase QTc interval. Use Caution/Monitor. - elagolix
elagolix decreases levels of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.
- eliglustat
primaquine and eliglustat both increase QTc interval. Use Caution/Monitor.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- encorafenib
encorafenib, primaquine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
- escitalopram
primaquine and escitalopram both increase QTc interval. Use Caution/Monitor.
- etravirine
etravirine will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- finerenone
primaquine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.
- fingolimod
fingolimod and primaquine both increase QTc interval. Use Caution/Monitor.
- flecainide
primaquine and flecainide both increase QTc interval. Use Caution/Monitor.
- flibanserin
primaquine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.
- fluconazole
primaquine and fluconazole both increase QTc interval. Use Caution/Monitor.
- fluoxetine
primaquine and fluoxetine both increase QTc interval. Use Caution/Monitor.
- fluphenazine
primaquine and fluphenazine both increase QTc interval. Use Caution/Monitor.
- fluvoxamine
primaquine and fluvoxamine both increase QTc interval. Use Caution/Monitor.
- fostemsavir
primaquine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- gemifloxacin
gemifloxacin and primaquine both increase QTc interval. Use Caution/Monitor.
- gilteritinib
gilteritinib and primaquine both increase QTc interval. Use Caution/Monitor.
- goserelin
primaquine and goserelin both increase QTc interval. Use Caution/Monitor.
- granisetron
granisetron and primaquine both increase QTc interval. Use Caution/Monitor.
- haloperidol
primaquine and haloperidol both increase QTc interval. Use Caution/Monitor.
- histrelin
primaquine and histrelin both increase QTc interval. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and primaquine both increase QTc interval. Use Caution/Monitor.
- ifosfamide
ifosfamide, primaquine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Ifosfamide may enhance the toxicities of myelosuppressive agents. Monitor for increased risk of myelosuppression.
- iloperidone
iloperidone increases levels of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.
- isavuconazonium sulfate
primaquine will increase the level or effect of isavuconazonium sulfate by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor.
- istradefylline
istradefylline will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
- itraconazole
itraconazole will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
itraconazole and primaquine both increase QTc interval. Use Caution/Monitor. - lapatinib
primaquine and lapatinib both increase QTc interval. Use Caution/Monitor.
- lemborexant
primaquine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.
- leuprolide
primaquine and leuprolide both increase QTc interval. Use Caution/Monitor.
- levofloxacin
primaquine and levofloxacin both increase QTc interval. Use Caution/Monitor.
- levoketoconazole
levoketoconazole will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lithium
lithium and primaquine both increase QTc interval. Use Caution/Monitor.
- loperamide
primaquine and loperamide both increase QTc interval. Use Caution/Monitor.
- lorlatinib
lorlatinib will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- maprotiline
primaquine and maprotiline both increase QTc interval. Use Caution/Monitor.
- mefloquine
primaquine and mefloquine both increase QTc interval. Use Caution/Monitor.
- midazolam intranasal
primaquine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.
- mirtazapine
mirtazapine and primaquine both increase QTc interval. Use Caution/Monitor.
- mitotane
mitotane decreases levels of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.
- nafcillin
nafcillin will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- octreotide
primaquine and octreotide both increase QTc interval. Use Caution/Monitor.
- ofloxacin
primaquine and ofloxacin both increase QTc interval. Use Caution/Monitor.
- olanzapine
olanzapine and primaquine both increase QTc interval. Use Caution/Monitor.
- osilodrostat
osilodrostat and primaquine both increase QTc interval. Use Caution/Monitor.
- oxaliplatin
oxaliplatin will increase the level or effect of primaquine by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.
- pasireotide
primaquine and pasireotide both increase QTc interval. Use Caution/Monitor.
- perphenazine
primaquine and perphenazine both increase QTc interval. Use Caution/Monitor.
- phenobarbital
phenobarbital will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- posaconazole
primaquine and posaconazole both increase QTc interval. Use Caution/Monitor.
- prochlorperazine
primaquine and prochlorperazine both decrease QTc interval. Use Caution/Monitor.
- promethazine
primaquine and promethazine both decrease QTc interval. Use Caution/Monitor.
- ranolazine
primaquine and ranolazine both increase QTc interval. Use Caution/Monitor.
- rifabutin
rifabutin will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifapentine
rifapentine will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rilpivirine
primaquine and rilpivirine both increase QTc interval. Use Caution/Monitor.
- risperidone
primaquine and risperidone both increase QTc interval. Use Caution/Monitor.
- romidepsin
primaquine and romidepsin both increase QTc interval. Use Caution/Monitor.
- rucaparib
rucaparib will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
- sertraline
primaquine and sertraline both increase QTc interval. Use Caution/Monitor.
sertraline and primaquine both increase QTc interval. Use Caution/Monitor. - solifenacin
primaquine and solifenacin both increase QTc interval. Use Caution/Monitor.
- stiripentol
stiripentol, primaquine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
- sunitinib
primaquine and sunitinib both increase QTc interval. Use Caution/Monitor.
- tacrolimus
primaquine and tacrolimus both increase QTc interval. Use Caution/Monitor.
- tazemetostat
tazemetostat will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tecovirimat
tecovirimat will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
- telavancin
primaquine and telavancin both increase QTc interval. Use Caution/Monitor.
- tetracaine
tetracaine, primaquine. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.
- tinidazole
primaquine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- triclabendazole
triclabendazole and primaquine both increase QTc interval. Use Caution/Monitor.
- trifluoperazine
primaquine and trifluoperazine both decrease QTc interval. Use Caution/Monitor.
- triptorelin
primaquine and triptorelin both increase QTc interval. Use Caution/Monitor.
- valbenazine
valbenazine and primaquine both increase QTc interval. Use Caution/Monitor.
- vardenafil
primaquine and vardenafil both increase QTc interval. Use Caution/Monitor.
- venlafaxine
primaquine and venlafaxine both decrease QTc interval. Use Caution/Monitor.
- voclosporin
primaquine and voclosporin both increase QTc interval. Use Caution/Monitor.
- voriconazole
primaquine and voriconazole both increase QTc interval. Use Caution/Monitor.
- vorinostat
primaquine and vorinostat both increase QTc interval. Use Caution/Monitor.
- warfarin
primaquine will increase the level or effect of warfarin by Other (see comment). Use Caution/Monitor. Warfarin's less potent R-enantiomer is metabolized in part by CYP3A4 (and also CYP1A2 and CYP2C19). Monitor INR more frequently if coadministered with inhibitors of these isoenzymes and adjust warfarin dose if needed.
- zidovudine
primaquine, zidovudine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of myelosuppression.
Minor (16)
- acetazolamide
acetazolamide will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- chloroquine
primaquine, chloroquine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hemolysis in G6PD deficient pts.
- cyclophosphamide
cyclophosphamide will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dapsone
primaquine, dapsone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hemolysis in G6PD deficient pts.
- isoniazid
primaquine, isoniazid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hemolysis in G6PD deficient pts.
- larotrectinib
larotrectinib will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- probenecid
primaquine, probenecid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hemolysis in G6PD deficient pts.
- quinine
primaquine, quinine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hemolysis in G6PD deficient pts.
- ribociclib
ribociclib will increase the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ruxolitinib
primaquine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ruxolitinib topical
primaquine will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- sulfadiazine
primaquine, sulfadiazine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hemolysis in G6PD deficient pts.
- sulfamethoxazole
primaquine, sulfamethoxazole. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hemolysis in G6PD deficient pts.
- sulfisoxazole
primaquine, sulfisoxazole. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hemolysis in G6PD deficient pts.
- tetrabenazine
primaquine and tetrabenazine both increase QTc interval. Minor/Significance Unknown.
Adverse Effects
>10%
Abdominal pain
Hemolytic anemia in G6PD deficiency
Nausea
Vomiting
<1-10%
Methemoglobinemia in NADH-methemoglobin reductase-deficient individuals
<1%
Agranulocytosis
Arrhythmias
Headache
Interference with visual accommodation
Leukopenia
Leukocytosis
Rash
Dizziness
Pruritus
Warnings
Contraindications
Severe glucose-6-phosphate dehydrogenase (G6PD) deficiency
Administration of quinacrine in patients receiving primaquine; administration of primaquine in patients who received quinacrine recently
Concurrent administration with other potentially hemolytic drugs or depressants of myeloid elements of the bone marrow
Acutely ill patients suffering from systemic disease manifested by tendency to granulocytopenia, such as rheumatoid arthritis and lupus erythematosus
Cautions
Due to potential for QT interval prolongation, monitor ECG when using primaquine in patients with cardiac disease, long QT syndrome, a history of ventricular arrhythmias, uncorrected hypokalemia and/or hypomagnesemia, or bradycardia (<50 bpm), and during concomitant administration with QT interval prolonging agents
Hemolytic anemia and G6PD deficiency
- Due to risk of hemolytic anemia in patients with G6PD deficiency, G6PD testing has to be performed before using primaquine; due to limitations of G6PD tests, physicians need to be aware of residual risk of hemolysis and adequate medical support and follow-up to manage hemolytic risk should be available; therapy should not be prescribed for patients with severe G6PD deficiency
- In case of mild to moderate G6PD deficiency, a decision to prescribe therapy must be based on an assessment of risks and benefits of using primaquine; if primaquine administration is considered, baseline hematocrit and hemoglobin must be checked before treatment and close hematological monitoring (eg at day 3 and 8) is required
- Adequate medical support to manage hemolytic risk should be available; when the G6PD status is unknown and G6PD testing is not available, a decision to prescribe therapy must be based on an assessment of risks and benefits of using this drug
- Risk factors for G6PD deficiency or favism must be assessed; baseline hematocrit and hemoglobin must be checked before treatment and close hematological monitoring (eg., at day 3 and 8) is required; adequate medical support to manage hemolytic risk should be available
- Discontinue use of primaquine phosphate promptly if signs suggestive of hemolytic anemia occur (darkening of urine, marked fall of hemoglobin or erythrocytic count)
- Hemolytic reactions (moderate to severe) may occur in individuals with G6PD deficiency and in individuals with a family or personal history of favism; areas of high prevalence of G6PD deficiency are Africa, Southern Europe, Mediterranean region, Middle East, South-East Asia, and Oceania; people from these regions have a greater tendency to develop hemolytic anemia (due to congenital deficiency of erythrocytic G6PD) while receiving primaquine and related drugs
Blood monitoring
- Since anemia, methemoglobinemia, and leukopenia have been observed following administration of large doses of this drug, the adult dosage of 1 tablet (= 15 mg base) daily for fourteen days should not be exceeded
- In G6PD normal patients it is also advisable to perform routine blood examinations (particularly blood cell counts and hemoglobin determinations) during therapy
- If primaquine phosphate is prescribed for an individual who has shown a previous idiosyncratic reaction to primaquine phosphate as manifested by hemolytic anemia, methemoglobinemia, or leukopenia; an individual with a family or personal history of hemolytic anemia or nicotinamide adenine dinucleotide (NADH) methemoglobin reductase deficiency, the person should be observed closely
- In all patients, the drug should be discontinued immediately if marked darkening of the urine or sudden decrease in hemoglobin concentration or leukocyte count occurs
Pregnancy & Lactation
Pregnancy
Contraindicated in pregnant women; even if a pregnant woman is G6PD normal, the fetus may not be; safe usage in pregnancy not established; use during pregnancy should be avoided except when in judgment of the physician benefit outweighs possible hazard
Sexually-active females of reproductive potential should have a pregnancy test prior to starting primaquine
Contraception
- Advise females of child bearing potential to use effective contraception (methods that result in less than 1% pregnancy rates) when receiving therapy and after stopping treatment until completion of an ongoing ovulatory cycle (eg, up to next menses)
- Advise treated males whose partners may become pregnant, to use a condom while on treatment and for 3 months after stopping treatment
Lactation
CDC recommends do not use in nursing women unless breast-fed infant has been determined not to have G6PD deficiency
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Disrupts Plasmodium mitochondria
Absorption
Absorption: Well absorbed
Peak Plasma Time: 1-2 hr
Metabolism
Metabolism: Hepatic to carboxyprimaquine (active)
Elimination
Half-life: 3.7-9.6 hr
Excretion: Urine (small amounts as unchanged drug)
Administration
Oral administration
Take without meals
If patient vomits within 30 minutes of taking a dose, then should repeat dose
Storage
Store at 25°C (77° F); excursions permitted to 15-30° C (59-86° F)
Dispense in tight, light-resistant container
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| primaquine oral - | 26.3 mg tablet |  | |
| primaquine oral - | 26.3 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
primaquine oral
PRIMAQUINE - ORAL
(PRIM-uh-kwin)
COMMON BRAND NAME(S): Primaquine
USES: Primaquine is used with other medications to prevent and treat malaria caused by mosquito bites in countries where malaria is common. Malaria parasites can enter the body through these mosquito bites, and then live in body tissues such as red blood cells or the liver. Primaquine is used after other medications (such as chloroquine) have killed the malaria parasites living inside red blood cells. Primaquine then kills the malaria parasites living in other body tissues. This prevents the return of the infection. Both drugs are needed for a complete cure. Primaquine belongs to a class of drugs known as antimalarials.The United States Centers for Disease Control provide updated guidelines and travel recommendations for the prevention and treatment of malaria in different parts of the world. Discuss the most recent information with your doctor before traveling to areas where malaria occurs.
HOW TO USE: Take this medication by mouth as directed by your doctor, usually once daily. Take with food to prevent stomach upset. Follow your doctor's directions exactly. Primaquine is usually taken for 2 weeks after you have left the malarious area. It is started during the last 1 to 2 weeks of your other malaria treatment or immediately after you have finished your other treatment. Primaquine should not be taken for more than 14 days for malaria treatment.The dosage is based on the kind of infection you have and your response to treatment. Take this medication regularly. To help you remember, take it at the same time every day.It is very important to continue taking this medication exactly as prescribed by your doctor. Do not take more or less of this drug than prescribed. Do not stop taking it before completing treatment, even if you feel better, unless directed to do so by your doctor. Skipping or changing your dose without approval from your doctor may cause prevention/treatment to be ineffective, cause the amount of parasite to increase, make the infection more difficult to treat (resistant), or worsen side effects.It is important to prevent mosquito bites (such as by using appropriate insect repellents, wearing clothes that cover most of the body, remaining in air-conditioned or well-screened areas, using mosquito nets, using insect-killing spray). Buy insect repellent before traveling. The most effective insect repellents contain diethyltoluamide (DEET). Ask your doctor or pharmacist to recommend the appropriate strengths of mosquito repellent for you/your children.No drug treatment is completely effective in preventing malaria. Get medical help right away if you develop symptoms of malaria (such as fever, chills, headache, other flu-like symptoms), especially while in the malarious area and even after completing this prescription. Quick treatment of malaria infection is needed to prevent serious, possibly fatal, outcomes.When using primaquine phosphate for treatment of infection, tell your doctor if your condition lasts or gets worse.
SIDE EFFECTS: Nausea, vomiting, dizziness, stomach upset, and abdominal cramps may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: signs of serious infection (such as sore throat that doesn't go away, high fever, severe chills), signs of a sudden loss of red blood cells (such as severe tiredness, brown urine, pale lips/nails/skin, fast heartbeat/breathing with usual activities), signs of a certain blood problem (methemoglobinemia, including bluish skin/lips/nails, headache, shortness of breath, lightheadedness, weakness, confusion, chest pain, sudden pounding heartbeat).Get medical help right away if you have any very serious side effects, including: fast/irregular heartbeat, severe dizziness, fainting.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking primaquine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: immune system disease (such as lupus, rheumatoid arthritis), blood problems (such as low white blood cell counts, anemia), history of blood problems due to primaquine (such as hemolytic anemia, methemoglobinemia), personal/family history of favism, low levels of certain blood enzymes (glucose-6-phosphate dehydrogenase-G6PD, NADH methemoglobin reductase).Your doctor may order a blood test to see if you have any enzyme deficiency before starting primaquine.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Primaquine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using primaquine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using primaquine safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially QT prolongation (see above).This medication must not be used during pregnancy. It may harm an unborn baby. Women of childbearing age should have a pregnancy test before starting this medication. It is important to prevent pregnancy during and after treatment with primaquine. Men and women must use reliable forms of birth control (such as condoms, birth control pills) during treatment. Men should continue to use birth control for at least 3 months after the end of treatment. Women should continue to use birth control for at least 1 menstrual cycle after the end of treatment. If you become pregnant or think you may be pregnant, tell your doctor right away. While you are pregnant, traveling to an area with malaria puts you and your infant at a much higher risk for death and other problems. The CDC recommends continuing your other malaria treatment (such as chloroquine) throughout pregnancy until delivery to prevent harm to your unborn baby (hemolytic anemia). After delivery, you may finish treatment with primaquine. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. The doctor should test your infant for G6PD deficiency before breast-feeding. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: penicillamine, quinacrine, drugs that may cause decreased blood cells (such as trimethoprim, zidovudine, pyrimethamine, azathioprine).
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: extreme drowsiness, seizures, fast/irregular heartbeat.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as G6PD blood test, blood cell counts) should be done before you start taking this medication and while you are taking it. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised March 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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