Adult dose and durationGiven alongside chloroquine, not instead of it. The US label's adult dose is 1 tablet - 26.3 mg, equal to a 15 mg base dose - taken once a day across a 14-day course, to clear the liver-stage parasites; it may be taken with or without food, though taking it with food may cut down on GI side effects. StatPearls' malaria article prints a heavier daily figure across the same 14 days: 30 mg if dosing an adult, 0.5 mg/kg for a child - and both are shown here because they genuinely differ; the licensed label's own schedule leads here. - Fourteen days, and the course is what prevents the relapse rather than what treats the attack. US label verbatim: "daily for 14 days", and the drug is "recommended only for the radical cure of vivax malaria, the prevention of relapse in vivax malaria, or following the termination of chloroquine phosphate suppressive therapy in an area where vivax malaria is endemic."
Paediatric doseNo paediatric dose is written here, deliberately. The US label states that safety and effectiveness in children have not been established. StatPearls' malaria article does give a child's figure - 0.5 mg/kg daily for the same 14 days - but it sits outside the label, and the drug's main hazard is haemolysis driven by G6PD status. A child with P. vivax belongs with a fever hospital that can test G6PD and monitor the blood count.
Dose sourcePrimaquine phosphate tablets, film coated (sanofi-aventis U.S. LLC) US prescribing information, Indications and Usage, Contraindications, Warnings and Dosage and Administration (DailyMed SetID 1bfbf4ae-81b8-4160-a00d-6322aadd4b59)
WhyStatPearls' malaria article names primaquine as the hypnozoiticidal drug added for P. vivax or P. ovale infection, clearing the parasites dormant in the liver and preventing the relapses that follow. It places the drug in the regimen: in a chloroquine-sensitive region, uncomplicated P. vivax or P. ovale is treated with chloroquine phosphate or hydroxychloroquine, plus a radical-cure drug - either 14 days of primaquine phosphate at 30 mg a day for an adult (0.5 mg/kg for a child), or tafenoquine as a single 300 mg dose. The US label's licensed use is the radical cure - preventing relapse - of vivax malaria. The card carried only the blood-stage drugs, so a returning traveller or a patient from Sudan or Yemen with P. vivax would have had the attack treated while the liver stage was left untouched. Egypt has no registered primaquine product, so no local brand or price can be shown; the row exists so a regimen started abroad or at a fever hospital can be recognised and completed.
Cautions- RED FLAG - G6PD must be tested before the first tablet, not after. US label verbatim: "Due to the risk of hemolytic anemia in patients with G6PD deficiency, G6PD testing must be performed before using primaquine. Before initiating treatment, obtain baseline hemoglobin and hematocrit." The label names the regions: "Areas of high prevalence of G6PD deficiency are Africa, Southern Europe, Mediterranean region, Middle East, South-East Asia, and Oceania." Egypt sits inside that list. The label gives no numeric enzyme-activity threshold - it contraindicates "Severe glucose-6-phosphate dehydrogenase (G6PD) deficiency" and, for mild to moderate deficiency or unknown status, requires a risk-benefit decision with "baseline hematocrit and hemoglobin" and "close hematological monitoring (e.g., at day 3 and 8)".
- CONTRAINDICATED OUTRIGHT in three groups: severe G6PD deficiency, pregnancy, and breastfeeding when the infant is known to be G6PD deficient or their G6PD status is unknown - all per the US label. StatPearls' malaria article bars the same two groups on its own reasoning: primaquine is not to be given in pregnancy, since it affects the fetus, and is not to be given in G6PD deficiency, since it triggers haemolysis - seen on the blood film as bite cells and Heinz bodies.
- Teach the patient what haemolysis looks like before they leave. US label verbatim: "Warn patients to discontinue the use of Primaquine phosphate Tablets promptly if signs suggestive of hemolytic anemia occur (such as darkening of the urine, pale skin, shortness of breath, dizziness, and fatigue) and to contact their healthcare professional immediately."
- Contraception is part of the prescription. US label verbatim: "Advise sexually active females of childbearing potential to use effective contraception (methods that result in less than 1% pregnancy rates) when using primaquine and for 6 months after stopping treatment). Advise treated males whose partners may become pregnant, to use a condom while on treatment and for 3 months after stopping treatment with primaquine." A pregnancy test comes first: "Sexually active females of reproductive potential should have a pregnancy test prior to starting treatment with primaquine."
- Methaemoglobinaemia and leukopenia are the other two blood risks. US label verbatim: "Advise all patients to seek immediate medical attention if signs of methemoglobinemia occur such as bluish lips or nails." and "Discontinue the use of primaquine promptly if there is a sudden decrease in leukocyte count."
- It does not treat the attack. The blood-stage drug on this card does that; primaquine is added to it. Giving primaquine alone to a febrile patient with parasitaemia treats nothing that is making them ill.
Egyptian brandsNo Egyptian brand matched — prescribe by generic name.