1921
Volume 80, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Primaquine (PQ) is recommended to prevent relapses in patients with malaria infection. However, treatment with PQ causes methemoglobinemia. In this study, we measured the methemoglobin (MetHB) levels in three groups of subjects who received PQ treatment at 0.58, 0.83, or 1.17 mg/kg/d. A total of 112 subjects were studied. MetHB levels were detected at ≥ 4% in 46–50% 1 day after PQ treatment in all three groups and 4–9% of subjects had MetHB levels ≥ 4% 15 days after treatment. Only subjects receiving the highest doses of PQ had mild and brief adverse events, and 17% of them were associated with treatment. We conclude that when PQ is administered under certain conditions (i.e., normal glucose-6-phosphate dehydrogenase activity, in non-pregnant subjects and with a light meal), daily doses as high as 1.17 mg/kg do not represent a serious risk of high MetHB levels to patients.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.2009.80.188
2009-02-01
2018-12-15
Loading full text...

Full text loading...

/deliver/fulltext/14761645/80/2/0800188.html?itemId=/content/journals/10.4269/ajtmh.2009.80.188&mimeType=html&fmt=ahah

References

  1. van Heijst NP, Metahemoglobinemia. IPCSIntox databank. Available at: http://www.intox.org/databank/documents/treat/treats/trt40_s.htm. Accessed November 1, 2007.
  2. Hall AH, Kulig KW, Rumack BH, 1986. Drug- and chemical-induced methaemoglobinaemia. Clinical features and management. Med Toxicol 1 : 253–260. [Google Scholar]
  3. Toxicologia.net, Índice de tóxicos. 16. Metahemoglobinizantes. Available at: http://wzar.unizar.es/stc/toxicologianet/pages/x/x16/01.htm. Accessed November 1, 2007.
  4. Bradberry SM, 2003. Occupational methaemoglobinaemia. Mechanisms of production, features, diagnosis and management including the use of methylene blue. Toxicol Rev 22 : 13–27. [Google Scholar]
  5. Medline-plus, Información en salud para todos. Enciclopedia médica en español. U.S. National Library of Medicine; National Institutes of Health, Department of Health and Human Services. Available at: http://www.nlm.nih.gov/medlineplus/spanish/ency/article/000562.htm#Nombres%20alternativos. Accessed November 1, 2007.
  6. Coleman MD, Coleman NA, 1996. Drug-induced methaemoglobi-naemia. Treatment issues. Drug Saf 14 : 394–405. [Google Scholar]
  7. Fonseca D, Mateus H, Silva C, Contreras N, Restrepo C, 2005. Deficiencia de glucosa 6-fosfato deshidrogenasa. Aspectos gen-erales de la eritroenzimopatía más frecuente en el mundo. Acta Med Colomb 30–64 : 59–64. [Google Scholar]
  8. Clayman CB, Arnold J, Hochwald RS, Yount EH, Edgcomb JH, Alving AS, 1952. Toxicity of primaquine in caucasians. JAMA 149 : 1563–1568. [Google Scholar]
  9. Hockwald RS, Arnold J, Clayman CB, Alving MD, 1952. Toxicity of primaquine to negroes. J Am Med Assoc 149 : 1568–1570. [Google Scholar]
  10. Frank JE, 2005. Diagnosis and management of G6PD deficiency. Am Fam Physician 72 : 1277–1282. [Google Scholar]
  11. Luzzatto L, 2006. Glucose 6-phosphate dehydrogenase deficiency: from genotype to phenotype. Haematologica 91 : 1303–1306. [Google Scholar]
  12. Santana MS, Rocha MA, Arcanjo AR, Sardinha JF, Alecrim WD, Alecrim MD, 2007. Associação de metemoglobinemia e defi-ciência de glicose-6-fosfato desidrogenase em pacientes com malária tratados com primaquina. Rev Soc Bras Med Trop 40 : 533–536. [Google Scholar]
  13. Carmona-Fonseca J, Álvarez G, Blair S, 2006. Malaria por Plasmodium vivax: curación del ataque agudo con tres dosis diferentes de primaquina y dosis fija de cloroquina. Antioquia, Colombia, 2003–2004. Biomedica (Bogota) 26 : 353–365. [Google Scholar]
  14. Álvarez G, Piñeros JG, Tobón A, Ríos A, Maestre A, Blair S, Carmona-Fonseca J, 2006. Efficacy of three chloroquine–pri-maquine regimens for treatment of Plasmodium vivax malaria in Colombia. Am J Trop Med Hyg 75 : 605–609. [Google Scholar]
  15. Beutler E, Duparc S, the G6PD Deficiency Working Group, 2007. Glucose-6-phosphate dehydrogenase deficiency and antimalar-ial drug development. Am J Trop Med Hyg 77 : 779–789. [Google Scholar]
  16. Arnold J, Alving AS, Clayman CB, 1961. Induced primaquine resistance in vivax malaria. Trans R Soc Trop Med Hyg 55 : 345–350. [Google Scholar]
  17. Collins WE, Jeffery GM, 1996. Primaquine resistance in Plasmodium vivax. Am J Trop Med Hyg 55 : 243–249. [Google Scholar]
  18. Schwartz E, Regev-Yochay G, Kurnik D, 2000. Short report: a consideration of primaquine dose adjustment for radical cure of Plasmodium vivax malaria. Am J Trop Med Hyg 63 : 393–395. [Google Scholar]
  19. Signorini L, Matteelli A, Castelnuovo F, Castelli F, Oladeji O, Carosi G, 1996. Short report: primaquine-tolerant P. vivax in an Italian traveler from Guatemala. Am J Trop Med Hyg 55 : 472–473. [Google Scholar]
  20. Goller JL, Jolley D, Ringwald P, Biggs BA, 2007. Regional differences in the response of Plasmodium vivax malaria to pri-maquine as anti-relapse therapy. Am J Trop Med Hyg 76 : 203–207. [Google Scholar]
  21. Lalloo DG, Shingadia D, Pasvol G, Chiodini PL, Whitty CJ, Beeching NJ, Hill DR, Warrell DA, Bannister BA; HPA Advisory Committee on Malaria Prevention in UK Travellers, 2007. UK malaria treatment guidelines. J Infect 54 : 111–121. [Google Scholar]
  22. Lwanga SK, Lameshow S, 1991. Determinación del Tamaño Muestral en los Estudios Sanitarios. Ginebra: OMS.
  23. Carmona-Fonseca J, 2003. La malaria en Colombia, Antioquia y las zonas de Urabá y Bajo Cauca: panorama para interpretar la falla terapéutica antimalárica. Parte 1. Iatreia 16 : 299–318. [Google Scholar]
  24. Carmona-Fonseca J, 2004. La malaria en Colombia, Antioquia y las zonas de Urabá y Bajo Cauca: panorama para interpretar la falla terapéutica antimalárica. Parte 2. Iatreia 17 : 34–53. [Google Scholar]
  25. Beutler E, 1967. Glucose-6-phosphate dehydrogenase deficiency. Diagnosis, clinical and genetic implications. Am J Clin Pathol 47 : 303–311. [Google Scholar]
  26. World Health Organization W.H.O., 2000. Severe falciparum malaria. Trans R Soc Trop Med Hyg 94 : 1–90. [Google Scholar]
  27. Menéndez-Capote R, Díaz-Pérez L, Luzardo-Suárez C, 1997. Hemólisis y tratamiento con primaquina. Informe Preliminar. Rev Cubana Med Trop 49 : 136–138. [Google Scholar]
  28. Ude A, 1993. Manual de Toxicología. Medellín: Universidad de Antioquia.
  29. Rodríguez-Fernández A, Del Pozo-Hessing C, 2005. Intoxicación por cianuro. Medisan 5 : 103–107. [Google Scholar]
  30. Fletcher KA, Evans DA, Gilles HM, Greaves J, Bunnag D, Harinasuta T, 1981. Studies on the pharmacokinetics of pri-maquine. Bull World Health Organ 59 : 407–412. [Google Scholar]
  31. Baird JK, Lacy MD, Basri H, Barcus MJ, Maguire JD, Bangs MJ, Gramzinski R, Sismadi P, Krisin, Ling J, Wiady I, Kusumaningsih M, Jones TR, Fryauff DJ, Hoffman SL; United States Naval MedicalResearchUnit2ClinicalTrialsTeam,2001.Randomized, parallel placebo-controlled trial of primaquine for malaria pro-phylaxis in Papua, Indonesia. Clin Infect Dis 33 : 1990–1997. [Google Scholar]
  32. Fryauff DJ, Baird JK, Basri H, Sumawinata I, Purnomo, Richie TL, Ohrt CK, Mouzin E, Church CJ, Richards AL, 1995. Randomised placebo-controlled trial of primaquine for prophylaxis of falci-parum and vivax malaria. Lancet 346 : 1190–1193. [Google Scholar]
  33. Soto J, Toledo J, Rodriquez M, Sanchez J, Herrera R, Padilla J, Berman J, 1998. Primaquine prophylaxis against malaria in nonimmune Colombian soldiers: efficacy and toxicity. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 129 : 241–244. [Google Scholar]
  34. Soto J, Toledo J, Rodriquez M, Sanchez J, Herrera R, Padilla J, Berman J, 1999. Double-blind, randomized, placebo-controlled assessment of chloroquine/primaquine prophylaxis for malaria in nonimmune Colombian soldiers. Clin Infect Dis 29 : 199–201. [Google Scholar]
  35. Weiss WR, Oloo AJ, Johnson A, Koech D, Hoffman SL, 1995. Daily primaquine is effective for prophylaxis against falciparum malaria in Kenya: comparison with mefloquine, doxycycline, and chloroquine plus proguanil. J Infect Dis 171 : 1569–1575. [Google Scholar]
  36. Clyde DF, McCarthy VC, 1977. Radical cure of Chesson strain vivax malaria in man by 7, not 14, days of treatment with pri-maquine. Am J Trop Med Hyg 26 : 562–563. [Google Scholar]
  37. Wilairatana P, Silachamroon U, Krudsood S, Singhasivanon P, Treeprasertsuk S, Bussaratid V, Phumratanaprapin W, Srivilirit S, Looareesuwan S, 1999. Efficacy of primaquine regimens for primaquine-resistant Plasmodium vivax malaria in Thailand. Am J Trop Med Hyg 61 : 973–977. [Google Scholar]
  38. Cohen RJ, Sachs JR, Wicker DJ, Conrad ME, 1968. Methemo-globinemia provoked by malarial chemoprophylaxis in Vietnam. N Engl J Med 279 : 1127–1131. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2009.80.188
Loading
/content/journals/10.4269/ajtmh.2009.80.188
Loading

Data & Media loading...

  • Received : 05 Dec 2007
  • Accepted : 20 Aug 2008

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error