Antimalarial
PREGNANCY RECOMMENDATION: Contraindicated
BREASTFEEDING RECOMMENDATION: No Human Data—Potential Toxicity
PREGNANCY SUMMARY
No reports describing the use of primaquine in human pregnancy have been located. Primaquine may cause hemolytic anemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Two 1978 references stated that pregnant patients at risk for this disorder should be tested accordingly (1), but if the G6PD status was unknown the drug should be withheld until after delivery (2). However, because the fetus is relatively G6PD-deficient (see below), the drug should not be used in pregnancy regardless of the mother’s status.
FETAL RISK SUMMARY
Primaquine phosphate is indicated for the radical cure (prevention of relapse) of vivax malaria. Animal reproduction studies were not provided by the manufacturer (3).
It is not known if primaquine phosphate crosses the human placenta. The molecular weight (about 455 for primaquine) is low enough that exposure of the embryo–fetus should be expected.
A 1982 article stated that if prophylaxis or treatment is required with primaquine, it should not be withheld (4). However, more recent reviews have concluded that the drug should not be used in pregnancy because primaquine causes acute hemolysis in those who are G6PD-deficient and because the fetus is relatively G6PD-deficient (5–7).
BREASTFEEDING SUMMARY
No reports describing the use of primaquine during human lactation have been located. The molecular weight (about 259 primaquine) is low enough for excretion into breast milk. The effect of this exposure on a nursing infant is unknown. However, the mother and the infant should be tested for G6PD deficiency before the drug is used during breastfeeding.
References
1.Trenholme GM, Parson PE. Therapy and prophylaxis of malaria. JAMA 1978;240:2293–5.
2.Anonymous. Chemoprophylaxis of malaria. MMWR 1978;27:81–90.
3.Product information. Primaquine Phosphate. Sanofi-Aventis U.S, 2013.
4.Diro M, Beydoun SN. Malaria in pregnancy. South Med J 1982;75:959–62.
5.Phillips-Howard PA, Wood D. The safety of antimalarial drugs in pregnancy. Drug Saf 1996;14:131–45.
6.Nosten F, McGready R, d’Alessandro U, Bonell A, Verhoeff F, Menendez C, Mutabingwa T, Brabin B. Antimalarial drugs in pregnancy: a review. Curr Drug Saf 2006;1:1–15.
7.Irvine MH, Einarson A, Bozzo P. Prophylactic use of antimalarials during pregnancy. Can Fam Physician 2011;57:1279–81.