Usual Adult Dose for Malaria

Manufacturer Recommendations: 15 mg base (26.3 mg salt) orally once a day for 14 days

Comments:

• Recommended only for the radical cure of vivax malaria, the prevention of relapse in vivax malaria, or after the end of chloroquine phosphate suppressive therapy in vivax malaria-endemic area
• Should be given with chloroquine phosphate (destroys erythrocytic parasites and stops attack) to destroy exoerythrocytic parasites

• Alternate regimen: 45 mg base (78.9 mg salt) orally once a week for 8 weeks

• For the radical cure of malaria due to P vivax or P ovale
• Since this drug usually is not active against asexual erythrocytic forms of plasmodia, it should be administered with other appropriate antimalarial agents.
• This drug eradicates any hypnozoites that may be dormant in the liver and, thus, prevent relapses.
• The alternate regimen is recommended for patients with borderline glucose-6-phosphate dehydrogenase (G6PD) deficiency or as an alternative to the daily regimen.
• If the alternate regimen is considered for use in those with borderline G6PD deficiency, consultation with an infectious disease and/or tropical medicine expert is recommended.
• This drug is not recommended for use during pregnancy but should be used after delivery in patients without G6PD deficiency.

Usual Adult Dose for Malaria Prophylaxis

Manufacturer Recommendations: 15 mg base (26.3 mg salt) orally once a day for 14 days

Comments: Recommended only for the radical cure of vivax malaria, the prevention of relapse in vivax malaria, or after the end of chloroquine phosphate suppressive therapy in vivax malaria-endemic area

Use: For the radical cure (prevention of relapse) of malaria due to P vivax

US CDC Recommendations: 30 mg base (52.6 mg salt) orally once a day

Comments:
When used for primary prophylaxis:

• Should be taken 1 to 2 days before travel to malarious areas, while in such areas, and for 7 days after leaving the areas
• Generally used for short-duration travel to areas with primarily P vivax.

• To reduce risk for relapses of malaria due to P vivax or P ovale; indicated for patients with prolonged exposure to P vivax, P ovale, or both
• This drug should be taken for 14 days after the patient has left the malarious area.
• When chloroquine, doxycycline, or mefloquine is used for primary prophylaxis, this drug should be used during the last 2 weeks of postexposure prophylaxis.
• When atovaquone-proguanil is used for prophylaxis, this drug may be used during the last week of atovaquone-proguanil plus an additional 7 days.
• Concurrent use of this drug with the primary prophylaxis agent is preferred; if not possible, this drug should still be used after the primary prophylactic agent has been finished.

Usual Adult Dose for Pneumocystis Pneumonia

US CDC, National Institutes of Health (NIH), and HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/IDSA) Recommendations for HIV-infected Patients: 30 mg base (52.6 mg salt) orally once a day
Duration of therapy: 21 days

Comments: In combination with clindamycin, recommended as an alternative regimen for mild-to-moderate Pneumocystis pneumonia (PCP) and moderate-to-severe PCP

Usual Pediatric Dose for Malaria

US CDC Recommendations: 0.5 mg/kg base (0.8 mg/kg salt) orally once a day for 14 days
Maximum dose: 30 mg base/dose

Comments:

• For the radical cure of malaria due to P vivax or P ovale
• Since this drug usually is not active against asexual erythrocytic forms of plasmodia, it should be administered with other appropriate antimalarial agents.
• This drug eradicates any hypnozoites that may be dormant in the liver and, thus, prevent relapses.

Usual Pediatric Dose for Malaria Prophylaxis

US CDC Recommendations: 0.5 mg/kg base (0.8 mg/kg salt) orally once a day
Maximum dose: 30 mg base/dose

Comments:
When used for primary prophylaxis:

• Should be taken 1 to 2 days before travel to malarious areas, while in such areas, and for 7 days after leaving the areas
• Generally used for short-duration travel to areas with primarily P vivax.

• To reduce risk for relapses of malaria due to P vivax or P ovale; indicated for patients with prolonged exposure to P vivax, P ovale, or both
• This drug should be taken for 14 days after the patient has left the malarious area.
• When chloroquine, doxycycline, or mefloquine is used for primary prophylaxis, this drug should be used during the last 2 weeks of postexposure prophylaxis.
• When atovaquone-proguanil is used for prophylaxis, this drug may be used during the last week of atovaquone-proguanil plus an additional 7 days.
• Concurrent use of this drug with the primary prophylaxis agent is preferred; if not possible, this drug should still be used after the primary prophylactic agent has been finished.

Usual Pediatric Dose for Pneumocystis Pneumonia

US CDC, NIH, HIVMA/IDSA, Pediatric Infectious Diseases Society, and American Academy of Pediatrics Recommendations for HIV-exposed and HIV-infected Children: 0.3 mg/kg base (0.526 mg/kg salt) orally once a day
Maximum dose: 30 mg base/dose

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Adolescents: 30 mg base (52.6 mg salt) orally once a day

Duration of therapy: 21 days

Comments:

• In combination with clindamycin, recommended as an alternative regimen for mild-to-moderate PCP (children and adolescents) and moderate-to-severe PCP (adolescents)
• Data not available for children; dosing based on use of these drugs to treat other infections.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Storage requirements:

• Close bottle tightly; protect from light.

• The dose of this drug is often expressed or calculated as the base. Each 26.3 mg tablet of primaquine phosphate is equivalent to 15 mg primaquine base.
• The US CDC recommends screening for G6PD deficiency before starting this drug.
• Current guidelines should be consulted for additional information.

• Hematologic: Routine blood examinations, especially blood cell counts and hemoglobin values (during therapy)