Relapse of Vivax Malaria Treated With Primaquine and Report of One Case of Cyanosis (Methemoglobinemia) Due to Primaquine

Hansen, James E.; Cleve, Edward A.; Pruitt, Francis W.

doi:10.1097/00000441-195401000-00002

Cited by 7 publications

(3 citation statements)

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“…12 Primaquine, an 8-aminoquinoline, has been the drug of choice for radical cure of P. vivax malaria since 1950. Although therapeutic application of primaquine is restricted because of its reported adverse events, [13][14][15][16][17] it is the only drug currently available to prevent relapse of P. vivax malaria. Numerous studies have shown relatively poor efficacy against relapse without supervision of compliance to the 14-day regimen.…”

Section: Introductionmentioning

confidence: 99%

High-dose Primaquine Regimens against Relapse of Plasmodium vivax Malaria

Krudsood¹,

Tangpukdee²,

Wilairatana³

et al. 2008

The American Journal of Tropical Medicine and Hygiene

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Abstract. Plasmodium vivax causes debilitating but usually non-lethal malaria in most of Asia and South America. Prevention of relapse after otherwise effective therapy for the acute attack requires a standard daily dose of primaquine administered over 14 days. This regimen has < 90% efficacy in Thailand, and is widely regarded as ineffective because of poor compliance over the relatively long duration of dosing. We evaluated the efficacy, safety, and tolerability of alternative primaquine dosing regimens combined with artesunate among 399 Thai patients with acute, symptomatic P. vivax malaria. Patients were randomly assigned to one of six treatment groups: all patients received artesunate, 100 mg once a day for 5 days. Groups 1-5 then received primaquine, 30 mg a day for 5, 7, 9, 11, and 14 days, respectively. Group 6 received primaquine, 30 mg twice a day for 7 days. The 28-day cure rates were 85%, 89%, 94%, 100%, and 96%, respectively. Treatment of P. vivax malaria with artesunate for 5 days followed by high-dose primaquine, 30 mg twice a day for 7 days, was highly effective, well-tolerated, and equivalent or superior to the standard regimen of primaquine therapy.

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Section: Introductionmentioning

confidence: 99%

High-dose Primaquine Regimens against Relapse of Plasmodium vivax Malaria

Krudsood¹,

Tangpukdee²,

Wilairatana³

et al. 2008

The American Journal of Tropical Medicine and Hygiene

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“…In general primaquine is well tolerated at individual doses ≤0.5 mg base/kg if given together with food [ 151 , 152 ]. Asymptomatic methemoglobinemia is common [ 153 ]. Symptoms develop when methemoglobin levels reach 10% of the normal level of hemoglobin.…”

Section: Treatment Of P V Ivax mentioning

confidence: 99%

Management of relapsingPlasmodium vivaxmalaria

Chu

White

2016

Expert Review of Anti-infective Therapy

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Introduction: Relapses are important contributors to illness and morbidity in Plasmodium vivax and P. ovale infections. Relapse prevention (radical cure) with primaquine is required for optimal management, control and ultimately elimination of Plasmodium vivax malaria. A review was conducted with publications in English, French, Portuguese and Spanish using the search terms ‘P. vivax’ and ‘relapse’. Areas covered: Hypnozoites causing relapses may be activated weeks or months after initial infection. Incidence and temporal patterns of relapse varies geographically. Relapses derive from parasites either genetically similar or different from the primary infection indicating that some derive from previous infections. Malaria illness itself may activate relapse. Primaquine is the only widely available treatment for radical cure. However, it is often not given because of uncertainty over the risks of primaquine induced haemolysis when G6PD deficiency testing is unavailable. Recommended dosing of primaquine for radical cure in East Asia and Oceania is 0.5 mg base/kg/day and elsewhere is 0.25 mg base/kg/day. Alternative treatments are under investigation. Expert commentary: Geographic heterogeneity in relapse patterns and chloroquine susceptibility of P. vivax, and G6PD deficiency epidemiology mean that radical treatment should be given much more than it is today. G6PD testing should be made widely available so primaquine can be given more safely.

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“…Dose-dependent action of primaquine to oxidize hemoglobin to methemoblobin (metHb) [164] , which leads to cyanosis, has been reported rarely [165,166] . Leucopenia (at high dose, Expert Opin.…”

Section: Adverse Effectsmentioning

confidence: 99%

Assessment of safety of the major antimalarial drugs

Chattopadhyay

Mahajan

Kumar

2007

Expert Opinion on Drug Safety

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Antimalarial drugs remain the major intervention tool for the global malaria control efforts that save millions of lives. Nonetheless, emergence and spread of Plasmodium parasites resistant against chloroquine and other major antimalarial drugs has brought the urgency to develop a new generation of safe and effective drugs against malaria. In this article, the safety data for major antimalarial drugs is reviewed. Although an ample amount of clinical data regarding the safety and tolerability of several of these drugs in older children and adults is available, more critical safety and tolerability studies in pregnant women and young children is desirable. To offset the partial loss in efficacy due to drug resistance in malaria parasites acquired against specific drugs, treatment regimens often rely upon the combination of two or more drugs. However, combination therapy requires additional safety, toxicity and tolerability studies in all population groups where these drugs are administered. A uniform standard in assessing the safety and tolerability of antimalarial drugs will be useful in the formulation and implementation of malaria treatment policies that are based on the drug effectiveness, safety and tolerability.

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Relapse of Vivax Malaria Treated With Primaquine and Report of One Case of Cyanosis (Methemoglobinemia) Due to Primaquine

Cited by 7 publications

References 0 publications

High-dose Primaquine Regimens against Relapse of Plasmodium vivax Malaria

High-dose Primaquine Regimens against Relapse of Plasmodium vivax Malaria

Management of relapsingPlasmodium vivaxmalaria

Assessment of safety of the major antimalarial drugs

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