Primaquine therapy for liver hypnozoite and gametocyte eradication13 19–22
| Species | Primaquine dose |
|---|---|
| Liver hypnozoite eradication | |
| P vivax (regardless of geographic region) | 0.5 mg/kg (up to 30 mg) orally daily (or divided 12 hourly if nausea) with food×14 days |
| P ovale | 0.25 mg/kg (up to 15 mg) orally daily with food×14 days |
| Species unknown | 0.5 mg/kg (up to 30 mg) orally daily (or divided 12 hourly if nausea) with food×14 days |
| Mild G6PD deficiency* | 0.75 mg/kg (up to 45 mg) orally weekly for 8 weeks |
| Gametocyte eradication | |
| P falciparum or P malariae | 0.75 mg/kg (up to 45 mg) orally, single administration, during primary anti-malarial oral therapy |
| P vivax, P ovale, or species unknown | Covered by liver hypnozoite eradication as above |
*The WHO classification of glucose-6-phosphate dehydrogenase (G6PD) variants:30
– Class I variants – very severe enzyme deficiency associated with chronic haemolytic anaemia
– Class II variants – severe enzyme deficiency (<10% of normal) without chronic haemolysis
– Class III variants – moderate enzyme deficiency (10 to 60% of normal) with intermittent haemolysis usually associated with infection or drugs
– Class IV variants – no enzyme deficiency or haemolysis
– Class V variants – increased enzyme activity.