Comprehensive medication guide to Primaquine including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0-$20 copay for generic on most commercial plans; Tier 1-2 placement on most formularies; some plans require prior authorization for prophylaxis quantities over 14 tablets.
Estimated Cash Pricing
$50-$60 retail for generic primaquine phosphate; as low as $24.35 with GoodRx or SingleCare coupons for a standard 14-tablet treatment course.
Medfinder Findability Score
40/100
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Primaquine phosphate is an 8-aminoquinoline antimalarial drug that has been FDA-approved since 1952. It is available only as a generic in the United States — there is no brand-name version. Each tablet contains 26.3 mg of primaquine phosphate, equivalent to 15 mg of the biologically active primaquine base.
Primaquine's primary FDA-approved use is radical cure — preventing relapse — of Plasmodium vivax malaria. P. vivax creates dormant liver-stage parasites called hypnozoites that can cause relapses months or years after the initial infection. Primaquine is one of only two FDA-approved drugs (along with tafenoquine) capable of eliminating these hidden parasites.
Beyond malaria treatment, the CDC recommends primaquine (off-label) as a prophylactic option for travelers to P. vivax-endemic regions. It is also used off-label for Plasmodium ovale anti-relapse therapy, and in combination with clindamycin for Pneumocystis pneumonia (PCP) treatment in immunocompromised patients.
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Primaquine is an 8-aminoquinoline that works through an oxidative mechanism. After absorption, it is metabolized primarily by the CYP3A4 enzyme into active hydroxylated metabolites. These metabolites generate reactive oxygen species (ROS) that are selectively toxic to malaria parasites — particularly the dormant hypnozoite forms hiding in liver cells.
The metabolites disrupt the parasite's mitochondrial electron transport chain, impairing energy (ATP) production and creating oxidative conditions incompatible with parasite survival. This mechanism explains why primaquine can eliminate hypnozoites that hide inside liver cells — where blood-stage antimalarials cannot reach.
Primaquine also has potent gametocytocidal activity, killing the sexual-stage forms of Plasmodium falciparum that enable mosquito-to-human transmission. This is why the WHO recommends low-dose primaquine in malaria elimination programs to interrupt disease transmission.
26.3 mg (= 15 mg base) — tablet
Standard formulation for radical cure (15 mg base/day x14 days) and prophylaxis (30 mg base/day). Only strength available in US.
As of 2026, primaquine is not in an official national shortage — it is commercially available from multiple generic manufacturers. However, it has a findability score of 40 out of 100, reflecting significant localized availability challenges. The core problem: most retail pharmacies don't stock primaquine routinely because it has very low prescription volume in the US.
Malaria is not endemic to the United States, so primaquine is a niche drug. Most prescriptions come from travel medicine clinics and infectious disease practices, and pharmacies adjacent to these practices rarely see enough demand to justify keeping the drug on their regular order cycle. Hospital outpatient pharmacies, travel medicine clinic dispensaries, and specialty pharmacies are significantly more likely to carry primaquine than standard retail chains.
If you've been prescribed primaquine and are having trouble filling it, medfinder calls pharmacies near you to check which ones have it in stock — saving you hours of frustrating phone calls.
Primaquine is not a controlled substance and has no DEA scheduling restrictions on prescribing. Any licensed physician, nurse practitioner (NP), or physician assistant (PA) with a valid prescribing license can authorize primaquine. However, because G6PD testing is required before dispensing and the drug targets malaria — a disease most US clinicians rarely encounter — it is most commonly prescribed by specialists familiar with tropical and travel medicine.
Infectious Disease (ID) Specialists — primary prescribers for active P. vivax infection requiring radical cure
Travel Medicine Physicians — primary prescribers for prophylaxis in pre-travel consultations
Primary Care Physicians (PCPs) — may prescribe for returning travelers they know well; refer to ID if unfamiliar with malaria management
Tropical Medicine Specialists — manage complex or refractory cases in academic medical center settings
Nurse Practitioners (NPs) and Physician Assistants (PAs) — can prescribe in travel medicine, infectious disease, and primary care settings per state scope of practice
Telehealth consultations for primaquine prescriptions are increasingly available through travel medicine platforms. Since primaquine is not a controlled substance, there are no scheduling barriers to telemedicine prescribing. However, providers will need documentation of G6PD testing before authorizing the prescription. Find a travel medicine clinic through the ISTM clinic locator at istm.org or the CDC's clinic directory at cdc.gov/travel.
No. Primaquine is not a controlled substance and is not scheduled under the DEA's Controlled Substances Act. It is a standard prescription-only medication, but there are no DEA scheduling restrictions on prescribing or dispensing. Any licensed physician, nurse practitioner, or physician assistant with a valid prescribing license can prescribe it, and pharmacies can dispense it without the additional recordkeeping and quantity restrictions that apply to scheduled drugs.
Prescriptions for primaquine can be called in, faxed, or sent electronically (e-prescribing). There are no state-level scheduling restrictions specific to primaquine, though prescribing of antimalarials is typically done by providers familiar with malaria management due to the mandatory G6PD testing requirement. The critical safety prerequisite — G6PD testing before use — is a medical requirement, not a regulatory one.
Most patients tolerate primaquine well when taken with food at recommended doses. Common side effects include:
Nausea and vomiting (most common; reduced by taking with food)
Stomach cramps and abdominal pain
Headache
Dizziness
Pruritus (skin itching)
Hemolytic anemia (dark/discolored urine, extreme fatigue, pallor) — especially in G6PD-deficient patients
Methemoglobinemia (bluish discoloration of lips/skin, difficulty breathing)
Leukopenia/granulocytopenia (fever, unusual infections, sore throat)
QT interval prolongation (palpitations, irregular heartbeat — especially with interacting drugs)
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Tafenoquine (Krintafel / Arakoda)
Only other FDA-approved anti-hypnozoite drug; single-dose for radical cure; requires quantitative G6PD testing; significantly more expensive.
Atovaquone-Proguanil (Malarone)
Widely available prophylactic; effective against blood-stage malaria; does not kill hypnozoites; no G6PD testing required.
Doxycycline
Inexpensive antibiotic used for malaria prophylaxis; broad availability; no hypnozoite activity; not for pregnant women or children under 8.
Mefloquine (Lariam)
Weekly prophylactic with black box warning for neuropsychiatric side effects; effective in chloroquine-resistant areas; no hypnozoite activity.
Chloroquine
Classic weekly prophylactic; widespread resistance limits use; safe in pregnancy; no hypnozoite activity.
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Quinacrine (Atabrine)
majorAbsolutely contraindicated. Quinacrine dramatically increases primaquine blood levels (3x or more), causing severe toxicity and hemolysis risk.
QTc-prolonging drugs (antipsychotics, fluoroquinolones, antifungals, antiarrhythmics)
majorAdditive QT interval prolongation increases risk of torsades de pointes and life-threatening arrhythmias.
Strong CYP3A4 inhibitors (clarithromycin, ritonavir, idelalisib, ketoconazole)
moderateIncrease primaquine blood levels by slowing metabolism; raises risk of hemolysis and other side effects.
Strong CYP3A4 inducers (carbamazepine, rifampin, apalutamide, St. John's Wort)
moderateDecrease primaquine blood levels by accelerating metabolism; may reduce efficacy of anti-relapse therapy.
Grapefruit juice
moderateInhibits CYP3A4, increasing primaquine exposure. Avoid all grapefruit products during treatment.
Chloroquine
minorOften co-administered with primaquine therapeutically. Monitor for additive GI effects; combination is clinically standard for P. vivax treatment.
Primaquine is one of medicine's most important but least-known drugs in the US context. It fills a unique therapeutic role — eliminating dormant liver-stage parasites that can cause malaria relapses — that no other widely available medication can replicate. For travelers to P. vivax-endemic regions and for patients returning with confirmed vivax malaria, primaquine is not just useful: it may be essential.
The most important steps before taking primaquine: get G6PD tested, review your medication list for interactions (especially quinacrine), and confirm you are not pregnant. The most important step during treatment: take it with food every day for the full prescribed course. Stopping early, even if you feel well, can leave hypnozoites in your liver.
If you have a prescription and are struggling to find a pharmacy that carries primaquine, medfinder can help. Simply enter your medication and location and we'll call pharmacies near you to find which ones have primaquine in stock — so you can skip the phone tree and get your treatment started.
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