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Review

Primaquine

No authors listed
In: Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006.
.
Free Books & Documents
Review

Primaquine

No authors listed.
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Excerpt

Primaquine and its metabolite are poorly excreted into breastmilk of nursing mothers and undetectable in the serum of their breastfed infants. Breastfed infants beyond the neonatal period have shown no evidence of hemolysis. Neonates and infants with glucose-6-phosphate dehydrogenase (G6PD) deficiency have not been studied, but G6PD-deficient infants over 28 days of age appear to have a low risk of hemolysis from exposure in breastmilk.[1-3] If primaquine is required, testing the mother and infant for G6PD deficiency is advisable before the drug is given to a nursing mother.

United Kingdom malaria treatment guidelines recommend that primaquine be avoided in nursing mothers with malaria and that weekly chloroquine 500 mg be given until breastfeeding is completed.[4] However, these guidelines were developed before information on the excretion of primaquine into breastmilk and safety in breastfed infants was published. More recent information indicates that all mothers nursing infant over 28 days of age could safely receive primaquine.[1] The Centers for Disease Control and Prevention guidelines state that primaquine may be used in breastfeeding mothers and infants with normal G6PD levels.[5] Because the small amounts of primaquine transferred in breast milk are insufficient to provide adequate protection or treatment of malaria, infants who require chemoprophylaxis or therapy must receive the recommended dosages of primaquine.

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References

    1. Watson J, Taylor WRJ, Bancone G, et al. Implications of current therapeutic restrictions for primaquine and tafenoquine in the radical cure of vivax malaria. PLoS Negl Trop Dis 2018;12:e0006440. - PMC - PubMed
    1. Pan X, Abduljalil K, Almond LM, et al. Supplementing clinical lactation studies with PBPK modeling to inform drug therapy in lactating mothers: Prediction of primaquine exposure as a case example. CPT Pharmacometrics Syst Pharmacol 2024;13:386-95. - PMC - PubMed
    1. Wattanakul T, Gilder ME, McGready R, et al. Population pharmacokinetic modelling of primaquine exposures in lactating women and breastfed infants. Nat Commun 2024;15:3851. - PMC - PubMed
    1. Lalloo DG, Shingadia D, Bell DJ, et al. UK Malaria Treatment Guidelines 2016. J Infect 2016;72:635-49. - PMC - PubMed
    1. Centers for Disease Control and Prevention. CDC Yellow Book 2020: Health Information for International Travel. New York: Oxford University Press 2019. https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-d...

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