Q: Do you have thoughts on or research backing primaquine?  Our travel doctor here recommended we have blood testing to see if we can take that one, I think because it is cheaper than Lariam (mefloquine) and Malarone.

A: A recent article by a panel of experts discusses this question. The basic conclusions are:

• Primaquine is an acceptable alternative for the prevention of malaria in all ages. It is similar in effectiveness to mefloquine.
• It should be started one day before travel, continued daily during travel and for seven days after leaving the malaria zone.
• A blood test is required before taking primaquine, to be sure that the blood cells will tolerate it (G6PD deficiency is a contraindication)

Primaquine may be a cheaper alternative than mefloquine or malarone, two of the other drugs that are recommended for malaria prevention in areas of chloroquine resistant malaria (i.e. most malarious areas). The third recommended drug, doxycycline, is inexpensive (in Nigeria) but cannot be used in children under 8 years of age.

Primaquine is not approved by the US FDA for prevention of malaria but that in itself does not mean that it is unsafe or ineffective, it simply has not gone through the process of approval.

Primaquine: report from CDC expert meeting on malaria chemoprophylaxis I. Am. J. Trop. Med. Hyg., 75(3), 2006, pp. 402-415.

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