Guidance for Using Tafenoquine for Prevention and Antirelapse Therapy for Malaria — United States, 2019

Julia C. Haston, MD; Jimee Hwang, MD; Kathrine R. Tan, MD

Disclosures

Morbidity and Mortality Weekly Report. 2019;68(42):1062-1068. 

In This Article

Recommendations

Tafenoquine is an additional FDA-approved antimalarial option for malaria prophylaxis in adults aged ≥18 years, and for antirelapse therapy in persons aged ≥16 years (Box).

Dosage and Indication

In adults traveling to areas with malaria, tafenoquine (Arakoda, 100 mg tablets) can be used for chemoprophylaxis for all species of malaria. The prophylactic dose is 200 mg daily for the 3 days preceding the trip, 200 mg weekly during the trip, and a single 200 mg dose during the week after returning. In persons aged ≥16 years, tafenoquine (Krintafel, 150 mg tablets) can be used for presumptive antirelapse therapy or PART for P. vivax and off-label for P. ovale. The single 300 mg antirelapse or PART dose should ideally overlap with blood-stage treatment or the last dose of prophylaxis. If this is not feasible, tafenoquine may be taken as soon as possible afterwards. PART is not necessary if primaquine or tafenoquine is taken for primary prophylaxis. Tafenoquine should be administered with food.

Contraindications and Warnings

Like primaquine, tafenoquine is contraindicated in persons with G6PD deficiency because it might cause hemolytic anemia. If G6PD status is unknown, quantitative G6PD testing must be performed to confirm normal activity before administration of tafenoquine. Qualitative G6PD testing might miss persons with intermediate deficiency and is inadequate to guide tafenoquine administration. Tafenoquine is contraindicated in pregnancy because of the unknown G6PD status of the fetus and should not be used in breastfeeding women if the infant has G6PD deficiency or if the infant's G6PD status is unknown. Because psychiatric adverse reactions were observed in persons with a previous history of psychiatric conditions, tafenoquine should not be used in these persons,[3,4] and other antimalarials could be considered for prophylaxis, or primaquine can be considered as an alternative for antirelapse therapy. Tafenoquine is contraindicated in persons with known hypersensitivity to 8-aminoquinolines.

Adverse Events and Reporting

Adverse events might be delayed in onset or duration because of tafenoquine's long half-life. Common adverse reactions include dizziness, nausea, vomiting, and headache. When used for prophylaxis, elevated liver enzyme levels, insomnia, depression, abnormal dreams, and anxiety were also observed. Suspected adverse reactions can be reported to FDA via MedWatch at https://www.fda.gov/safety/medwatch.

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