Version July 2025
| Available antirelapse (hypnozoiticidal) agents* | Exclusion criteria | Antimalarial (blood schizonticidal) regimen | G6PD activity¶ | |||
| ≥70% | 30 to <70% | <30% | Unavailable | |||
| PrimaquineΔ Tabs:
Oral suspension may be available from compounding pharmacy |
| Chloroquine or an artemisinin combination regimen | Adults and children:
| Adults and children:
| Adults and children:
| Adults and children:
|
| Tafenoquine Tabs:
Dispersible tabs (available in some areas)‡:
|
| Chloroquine | Adults and children >35 kg‡:
Children ≤35 kg and aged >2 years‡:
| Not recommended | Not recommended | Not recommended |
G6PD: glucose-6-phosphate dehydrogenase; WHO: World Health Organization.
* Patients treated with primaquine or tafenoquine should be counseled to report signs of drug-induced hemolysis (dark urine, fatigue, or shortness of breath); in such cases, the drug should be discontinued.
¶ A quantitative G6PD assay is preferred over a qualitative assay. For patients with a "normal" G6PD result using a qualitative assay, primaquine should be dosed for 30% to <70% G6PD activity. Use of tafenoquine requires a quantitative G6PD activity assay result >70%.
Δ In the United States and Canada, pill strengths for primaquine are labeled in salt; elsewhere, pill strengths may be labeled as equivalent base. 26.3 mg primaquine salt is equivalent to 15 mg base. The gastrointestinal tolerability of primaquine can be improved by administering with food.
◊ Doses of primaquine in patients ≥70 kg should be adjusted to a total dose of 7 mg base/kg divided into doses of 30 mg base per day. The duration of treatment is extended beyond 14 days to achieve total cumulative dose of 7 mg base/kg without exceeding the maximum of 30 mg base per day. The primaquine dosing regimen differs from 2022 WHO guidance; refer to UpToDate topic review of nonfalciparum malaria, section on rationale for use of high-dose primaquine.[1,2]
§ Patients should be evaluated on day 7 to evaluate for adverse effects.
¥ This regimen is sufficient for preventing most P. ovale relapses and is efficacious for prevention of P. vivax relapse for infection acquired in temperate areas and areas of lower relapse periodicity. Patients should be monitored for hemolysis. Refer to the UpToDate topic on nonfalciparum malaria for further discussion.
‡ Pediatric tafenoquine formulation and dosing in children and adolescents aged >2 through 15 years is licensed in Australia but not in the United States.[3]