No

Aminoquinoline (Antimalarial)

Provides radical cure of P. vivax or P. ovale malaria after a clinical attack has been confirmed by blood smear or serologic titer and postexposure prophylaxis

C

Acutely ill patients who have a tendency to develop granulocytopenia (rheumatoid arthritis, SLE); patients receiving other drugs capable of depressing the bone marrow (eg, quinacrine and primaquine)

Use with caution in patients with G-6-PD deficiency, NADH methemoglobin reductase deficiency, acutely ill patients who have a tendency to develop granulocytopenia; patients receiving other drugs capable of depressing the bone marrow; do not exceed recommended dosage

>10%:

Gastrointestinal: Abdominal pain, nausea, vomiting

Hematologic: Hemolytic anemia in G-6-PD deficiency

1% to 10%: Hematologic: Methemoglobinemia in NADH-methemoglobin reductase-deficient individuals

<1%: Arrhythmias, headache, pruritus, leukopenia, agranulocytosis, leukocytosis, interference with visual accommodation

Symptoms of acute overdose include abdominal cramps, vomiting, cyanosis, methemoglobinemia (possibly severe), leukopenia, acute hemolytic anemia (often significant), granulocytopenia; with chronic overdose, symptoms include ototoxicity and retinopathy

Following GI decontamination, treatment is supportive (fluids, anticonvulsants, blood transfusions, methylene blue if methemoglobinemia severe - 1-2 mg/kg over several minutes)

Quinacrine may potentiate the toxicity of antimalarial compounds which are structurally related to primaquine

Eliminates the primary tissue exoerythrocytic forms of P. falciparum; disrupts mitochondria and binds to DNA

Absorption: Oral: Well absorbed

Metabolism: Liver metabolism to carboxyprimaquine, an active metabolite

Half-life: 3.7-9.6 hours

Time to peak serum concentration: Within 1-2 hours

Elimination: Only a small amount of unchanged drug excreted in urine

Oral:

Adults: 15 mg/day (base) once daily for 14 days or 45 mg base once weekly for 8 weeks

CDC treatment recommendations: Begin therapy during last 2 weeks of, or following a course of, suppression with chloroquine or a comparable drug

Periodic CBC, visual color check of urine, glucose, electrolytes; if hemolysis suspected - CBC, haptoglobin, peripheral smear, urinalysis dipstick for occult blood

None reported

Contraindicated in patients receiving clozapine or carbamazepine

No information available to require special precautions

No effects or complications reported

It is important to complete full course of therapy for full effect. May be taken with meals to decrease GI upset and bitter aftertaste. Avoid alcohol. You should have regular ophthalmic exams (every 4-6 months) if using this medication over extended periods. You may experience nausea, vomiting, or loss of appetite (small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help). Report persistent GI disturbance, chest pain or palpitation, unusual fatigue, easy bruising or bleeding, visual or hearing disturbances, changes in urine (darkening, tinged with red, decreased volume), or any other persistent adverse reactions. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant, contraception may be recommended. Consult prescriber if breast-feeding.

Monitor periodic CBC, visual color check of urine

Tablet: 26.3 mg [15 mg base]

Lynk A and Gold R, "Review of 40 Children With Imported Malaria," Pediatr Infect Dis J, 1989, 8(11):745-50.

Panisko DM and Keystone JS, "Treatment of Malaria - 1990," Drugs, 1990, 39(2):160-89.

White NJ, "The Treatment of Malaria," N Engl J Med, 1996, 335(11):800-6.

Wyler DJ, "Malaria Chemoprophylaxis for the Traveler," N Engl J Med, 1993, 329(1):31-7.