AIDS TREATMENT NEWS No. 113 - October 19, 1991
John S. James
Primaquine is usually used to treat or prevent certain kinds of malaria. In AIDS it is used in combination with clindamycin to treat or prevent pneumocystis -- but only for patients who cannot tolerate or do not benefit from all three of the preferred treatment regimens -- Bactrim (Septra), pentamidine, and dapsone.
The supply was cut off because the sole U.S. manufacturer of primaquine, Winthrop Pharmaceuticals, has been unable to obtain a chemical precursor needed to make the drug. The U.S. Centers for Disease Control obtained an emergency supply, which it will provide free to physicians for treatment of certain kinds of malaria (but not for malaria prophylaxis, because the supply is limited). Apparently no provision was made for persons with AIDS, for whom use of the drug is "off label," as primaquine has not been officially approved specifically for pneumocystis.
What is not widely known is that this shortage exists only in the United States. Elsewhere, primaquine is cheap and plentiful. Apparently the foreign manufacturers are unwilling to invest the money required to obtain generic approval for their preparations, since there is little malaria here, few other patients need the drug, and the profit margin is low because primaquine is generic.
In response to this emergency, the PWA Health Group in New York has obtained primaquine from England. (Individuals can legally import small quantities of foreign pharmaceuticals for personal use.) A bottle of 1,000 tablets (7.5 mg) costs $34; a prescription is required. For more information, call the PWA Health Group at 212/532-0280.
Note: An article on the primaquine supply problem appears in the excellent September, 1990, issue of Notes from the Underground, the newsletter of the PWA Health Group. For a copy, call them at the number above. An article in the July 20, 1990, Morbidity and Mortality Weekly Report, published by the U. S. Centers for Disease Control, alerted the medical community to the supply problem, and explained the arrangements made for patients with malaria.
California note: The California legislature recently passed a law to add clindamycin (the drug used with primaquine) to the Medi-Cal (Medicaid) formulary, allowing it to be prescribed to Medi-Cal patients. State authorities had previously refused to pay for the drug.
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