Primaquine is the only widely available drug that clears the liver stage of P. vivax and prevents relapse. In G6PD deficiency it can cause haemolysis, which can be severe.
India has a substantial prevalence of G6PD deficiency, varying by community and region. Qualitative point-of-care G6PD tests are available in many programme settings. Where deficiency is found, a weekly primaquine regimen under supervision is used instead of the daily course, according to national guidance.
- Check G6PD status before starting primaquine whenever testing is available.
- Primaquine is contraindicated in pregnancy and in infants under 6 months, and under 1 year in Indian national guidance.
- Warn patients to report dark urine, jaundice or breathlessness during treatment.
- Emphasise completing all 14 days; incomplete primaquine courses are a common cause of relapse.
Why it matters
A relapse prevented depends on a full, safe primaquine course, and the first safety step is a G6PD test.
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