Tafenoquine and G6PD: a primer for clinicians

Area of Science:

• Pharmacology
• Infectious Diseases
• Genetics

Background:

• Tafenoquine, an 8-aminoquinoline, is indicated for malaria prophylaxis and radical cure.
• It can cause hemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency.
• Intermediate G6PD activity also poses a hemolysis risk, necessitating careful prescription guidelines.

Purpose of the Study:

• To review the safe prescription of tafenoquine based on G6PD status.
• To provide guidance for clinicians on managing tafenoquine use in travelers.

Main Methods:

• A literature search was conducted using terms related to tafenoquine, primaquine, and G6PD deficiency.
• Data were gathered and interpreted to review tafenoquine prescribing practices concerning G6PD status.

Main Results:

• Tafenoquine is recommended only for individuals with G6PD activity >70% of the local median.
• Qualitative G6PD testing suffices for males, but quantitative testing is essential for females.
• Mandatory G6PD testing and measures to exclude ineligible individuals (considering age, pregnancy, lactation) are vital.

Conclusions:

• G6PD status is critical for the safe prescription of tafenoquine.
• Clinicians must maintain a high index of suspicion for hemolysis and seek evidence-based management strategies.
• Primaquine remains an alternative for certain patient groups.