From the Guidelines
Patients with a family history of anemia who develop malaria should not be given primaquine or tafenoquine. These medications can trigger severe hemolytic anemia in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, a genetic condition that often runs in families with a history of anemia 1. Before prescribing these medications, G6PD testing should be performed to determine if the patient has this enzyme deficiency.
Key Points to Consider
- Alternative antimalarial medications that are safer for patients with potential G6PD deficiency include:
- Artemisinin-based combination therapies (ACTs)
- Chloroquine (for sensitive strains)
- Atovaquone-proguanil
- Mefloquine
- The concern with primaquine and tafenoquine stems from their oxidative stress mechanism, which can cause red blood cell destruction in G6PD-deficient individuals who lack the enzymatic protection against oxidative damage 1.
- This hemolysis can be life-threatening and may require blood transfusions, so proper screening and medication selection are essential for safe malaria treatment in patients with family histories suggesting possible G6PD deficiency 1.
Treatment Options
- For uncomplicated malaria, options include dihydroartemisinin-piperaquine, artemether-lumefantrine, atovaquone-proguanil, and mefloquine 1.
- For complicated malaria, artesunate is the preferred treatment, with quinine sulphate plus doxycycline or clindamycin as alternative options 1.
From the FDA Drug Label
Who should not take mefloquine? Do not take mefloquine if you have: • an allergy to quinine, quinidine, mefloquine or any ingredients in mefloquine
What should I tell my doctor before taking mefloquine Before taking mefloquine, tell your doctor about all your medical conditions, including if you have: • blood clotting problems or take blood thinner medicines (anticoagulants) • mental problems • are pregnant or plan to become pregnant. It is not known if mefloquine will harm your unborn baby
The medication that should not be given to a person with a family history of anemia who developed malaria is not directly stated in the provided drug labels. However, considering the information provided, mefloquine may not be the best option due to potential blood clotting problems and the fact that it's not explicitly stated as safe for individuals with a history of anemia. On the other hand, chloroquine does not have explicit warnings regarding anemia, but its use is limited by resistance and specific treatment guidelines. Given the information from 2 and 3, a conservative clinical decision would be to avoid mefloquine due to its potential side effects and lack of explicit safety information for individuals with a family history of anemia. However, the best course of action would be to consult a doctor for a personalized recommendation.