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Pyrimethamine
Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
04-03-2008
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Available formulation in Zambia: 25 mg tablet
- Due to additive bone marrow suppression, co-administer AZT with caution or use other NRTI.
- First line treatment of CNS toxoplasmosis: pyrimethamine + sulfadiazine (plus folinic acid)
Zambia Information Author: Paul A. Pham, Pharm.D.
- Malaria (acute) in combination with sulfadoxine and quinine in the treatment of chloroquine-resistant Plasmodium falciparum malaria.Resistance prevalent worldwide; not recommended as a prophylactic agent for travelers to most areas.
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Toxoplasmosis (in combination with sulfadiazine or clindamycin plus leucovorin).
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
|
Daraprim
| Pyrimethamine | GlaxoSmithKline | oral
tablet
25 mg | $0.58 |
|
Fansidar
| Pyrimethamine/sulfadoxine | Roche | oral
tablet
Pyrimethamine 25 mg + sulfadoxine 500 mg | $3.92 |
*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.
- CNS toxoplasmosis, induction therapy: 200 mg x1, then 50-75 mg/d (+ folinic acid 10-20 mg/d + sulfadiazine 1.5 gm q6h or clindamycin 600 mg IV q6h) x >6 wks.
- CNS toxoplasmosis, maintenance therapy: 25-50 mg (+ folinic acid 15 mg + sulfadiazine 0.5-1 gm q6h or clindamycin 300-450 mg q6h) until immune reconstitution (CD4 >200 x 6 mos, induction therapy completed, and asymptomatic).
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Toxoplasmosis?prophylaxis: 50 mg/wk (+ folinic acid 25mg/wk + dapsone 50-100 mg daily + leucovorin 25 mg/wk OR atovaquone 1500 mg/d +/- pyrimethamine 25 mg/d + leucovorin 10 mg/d). Note: TMP/SMX 1DS daily preferred.
- Acute malaria, acute: Fansidar 2 to 3 tabs (pyrimethamine 50-75 mg/sufadoxine 1000-1500 mg) as a single dose.
- Malaria prophylaxis: Fansidar 1 tab (pyrimethamine 25mg/sulfadoxine 500mg) q week or OR 2 tabs every other week; start 1 to 2 days before arrival in endemic area and continue during stay and for 4 to 6 wk after leaving endemic area. Generally not recommended due to a high incidence of rash.
Usual dose.
Usual dose.
Usual dose; HD: no data, usual dose likely. dose post-HD on days of HD.
No data, usual dose likely (dose post-HD on days of HD).
47% removed after PD.
No data. Usual dose likely.
- Reversible pancytopenia (megaloblastic anemia, leucopenia, agranulocytosis, and thrombocytopenia) secondary to depletion of folic acid stores. Generally prevented with co-administration of leucovorin.
- GI intolerance: abdominal pain and vomiting (improved by administration with meals).
- Headache, dizziness, and insomnia.
- With sulfonamide co-administration: rash, hepatitis.
- Neurologic: tremors, ataxia, and seizure.
- With sulfonamide co-administration: Stevens-Johnson syndrome, TEN, erythema multiforme and anaphylaxis can occur.
P. falciparum, T. gondii
Treatment of choice (with sulfadiazine and leucovorin) for CNS toxoplasmosis. Fansidar (pyrimethamine/sulfadoxine) is not a first line agent for malaria prophylaxis due to high incidence of rash and the availability of better tolerated alternatives (e.g. atovaquone/proguanil, mefloquine, and doxycycline).
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