USE OF PRIMAQUINE IN PREGNANCY

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(Date of issue: October 2015, Version: 1.1)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

Summary

Primaquine is used in the treatment of benign malarias caused by Plasmodium vivax and Plasmodium ovale to eliminate the dormant forms of the parasite (hypnozoites). Initial treatment is with chloroquine which suppresses the disease but does not act on the hypnozoites which can persist in the liver and cause relapses of malaria. Primaquine is used after chloroquine to act on the malaria hypnozoites and eliminate the pathogen completely. It is the only drug available for this indication.

There are no published data on the use of primaquine in pregnancy and it should not be used in pregnancy. In the treatment of P. vivax and P. ovale malarias, once the course of chloroquine treatment has been completed, pregnant women should take weekly chloroquine prophylaxis until after delivery when hypnozoite eradication with primaquine can then be considered.

Following use in the third trimester there is a theoretical risk of neonatal haemolysis and methaemoglobinaemia as primaquine may cause haemolysis in G6PD deficient individuals.

Inadvertent exposure to primaquine in pregnancy would not usually be regarded as medical grounds for termination of pregnancy.  Due to the lack of data additional fetal monitoring may be warranted. Other risk factors may also be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case specific risk assessments.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.