Primaquine

The Basics

What is Primaquine?

Used alone or with another medication to treat malaria.

Brand names for Primaquine

Primaquine

How Primaquine is classified

Anti-infective Agents, Antiparasitic Agents, Antimalarials, Antiprotozoal Agents

Primaquine During Pregnancy

Primaquine pregnancy category

Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Primaquine while pregnant

N/A

Taking Primaquine While Breastfeeding

What are recommendations for lactation if you're taking Primaquine?

Primaquine is 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, however, G6PD-deficient infants over 28 days of age appear to have a low risk of hemolysis from exposure in breastmilk.[1] 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.[2] 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.[3] 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.

Maternal / infant drug levels

Primaquine is 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, however, G6PD-deficient infants over 28 days of age appear to have a low risk of hemolysis from exposure in breastmilk.[1] 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.[2] 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.[3] 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.

Possible effects of Primaquine on milk supply

Relevant published information was not found as of the revision date.

Possible alternatives to Primaquine

Atovaquone and Proguanil, Chloroquine, Doxycycline, Mefloquine.