Zambian HIV Guidelines:: Primaquine

	Zambia HIV National Guidelines
	Introduction HIV Counseling and Testing Sexually Transmitted Infections (STIs) General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents Initial Regimen for ARV Therapy Adherence Baseline evaluation and Monitoring Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance ARV Therapy for Individuals with Tuberculosis Co-Infection Adverse Effects and Toxicity Immune Reconstitution Inflammatory Syndrome (IRIS) Changing or Stopping ART Treatment Failure Stopping ARV Therapy Post Exposure Prophylaxis Cotrimoxazole Prophylaxis WHO Staging in Adults and Adolescents Nutrition Care and Support Palliative Care in HIV and AIDS
	Guide Editors
	Editor In Chief Joel E. Gallant, MD, MPH Pharmacology Editor Paul Pham, PharmD, BCPS Zambia Guideline Team Peter Mwaba MMed PhD FRCP Alywn Mwinga MMed Isaac Zulu MMed MPH Velepie Mtonga MMed Albert Mwango MBChB Jabbin Mulwanda MMed FCS

Drugs>Antimicrobial Agents>

Primaquine

Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
03-18-2008

Available formulation in Zambia: Tablet: 7.5 mg; 15 mg (as diphosphate)
P. ovale and P. vivax malaria: primaquine 15 mg (0.25mg/kg base) qd x 14 days PLUS chloroquine.
PCP treatment in SMX/TMP allergic pts: Clindamycin 600 mg q8h plus primaquine 15 mg qd x 21 days.
Check for G-6-PD deficiency. Avoid with severe G-6-PD deficiency (<10% residual enzyme activity), but lower doses of primaquine (0.5-0.7 mg/kg) may be used in mild G-6-PD deficiency (10-60% residual enzyme activity).

REFERENCES

Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

Malaria prevention of relapses (radical cure) caused by Plasmodium vivax. Also effective against gametocytes of P. falciparum.

NON-FDA APPROVED USES

Treatment of PCP (in combination with clindamycin).

FORMS

brand name	generic	Mfg	brand forms	cost*
Primaquine	Primaquine	Sanofi Synthelabo INC	oral tablet 26.3 mg (15 mg base)	$1.17

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

Treatment of PCP: 15-30 mg (base) qd with food (in combination with clindamycin).

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

Usual dose; HD: no data, dose post-HD.

DOSING IN HEMODIALYSIS

No data.

DOSING IN PERITONEAL DIALYSIS

No data.

DOSING IN HEMOFILTRATION

No data.

ADVERSE DRUG REACTIONS

OCCASIONAL

Hemolytic anemia (in pts with G6-PD deficiency). Screen for G6-PD deficiency (African American men and Mediterranean descendent males).
Methemoglobinemia.
Neutropenia and leukopenia (incidence may be higher with primaquine 30 mg).
GI intolerance (abdominal pain, nausea, and vomiting).

RARE

Blurred vision
Headache
Pruritis

DRUG INTERACTIONS

Bone marrow suppressive drugs (i.e AZT, ganciclovir, pyrimethamine, flucytosine): Potential for additive bone marrow suppression with co-administration.

SPECTRUM

Pneumocystis jiroveci (formerly P. carinii)Plasmodium vivax, and Plasmodium falciparum (gametocyte form)

PHARMACOLOGY

Pharmacology

COMMENTS

Primaquine in combination with clindamycin is a good second line treatment for P. carinii in pts intolerant of TMP/SMX. Prior screening for G6-PD deficiency recommended to prevent hemolytic anemia.

REFERENCES

REFERENCED WITHIN THIS GUIDE

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Abbreviations