Adverse Reactions and Contraindications to Antimalarial Drugs

Artemether/lumefantrineArtemether/lumefantrine

Headache, anorexia, dizziness, asthenia (usually mild)

With lumefantrine, prolonged QT interval

Allergy to artemether/lumefantrineAllergy to artemether/lumefantrine

During pregnancy, used if potential benefit justifies potential risk to fetus, which is usually the case in the second and third trimesters and probably the first

Use of mefloquine prophylaxisUse of mefloquine prophylaxis

ArtesunateArtesunate

Asthenia, anorexia (usually mild)

Delayed hemolysis (hemoglobin levels should be monitored for 4 weeks after therapy)

Allergy to artesunate Allergy to artesunate

During pregnancy, used if potential benefit justifies potential risk to fetus, which is the case in most patients with severe malaria requiring parenteral therapy

Atovaquone/proguanilAtovaquone/proguanil

Gastrointestinal disturbances (abdominal pain, nausea, vomiting, diarrhea), headache, dizziness, rash, pruritus

Not recommended for use by pregnant people due to insufficient data on its safety in pregnancy

Hypersensitivity, breastfeeding (chestfeeding)*, severe renal impairment (creatinine clearance < 30 mL/min)

ChloroquineChloroquine

HydroxychloroquineHydroxychloroquine

Gastrointestinal disturbances, headaches, dizziness, blurred vision, rashes or pruritus, exacerbation of psoriasis, blood dyscrasias, alopecia, ECG changes including prolonged QTc interval, retinopathy, psychosis (rare)

Hypersensitivity, retinal or visual field disorders, or potential drug interactions resulting in prolonged QTc interval and arrhythmia

ClindamycinClindamycin

Hypotension, bone marrow toxicity, renal dysfunction, rashes, jaundice, tinnitus, Clostridium difficile infection (pseudomembranous colitis)

Hypersensitivity

DoxycyclineDoxycycline

Gastrointestinal upset, photosensitivity, vaginal candidiasis, C. difficile infection, erosive esophagitis

Pregnancy

Children < 8 years

Halofantrine

Prolongation of PR and QT intervals, cardiac arrhythmia, hypotension, gastrointestinal disturbances, dizziness, mental changes, seizures, sudden death

During pregnancy, used only if potential benefit justifies potential risk to fetus

Cardiac conduction defects, familial QT prolongation, use of drugs that affect QT interval, hypersensitivity

MefloquineMefloquine

Bad dreams, neuropsychiatric symptoms, dizziness, vertigo, confusion, psychosis, seizures, sinus bradycardia, gastrointestinal disturbances

Hypersensitivity, history of seizures or psychiatric disorders, cardiac conduction disturbances or arrhythmia, coadministration of drugs that may prolong cardiac conduction (eg, beta-blockers, calcium channel blockers, quinine, quinidine, halofantrine), occupations that require fine coordination and spatial discrimination and in which vertigo may be life threateningHypersensitivity, history of seizures or psychiatric disorders, cardiac conduction disturbances or arrhythmia, coadministration of drugs that may prolong cardiac conduction (eg, beta-blockers, calcium channel blockers, quinine, quinidine, halofantrine), occupations that require fine coordination and spatial discrimination and in which vertigo may be life threatening

QuinineQuinine

Gastrointestinal disturbances, tinnitus, visual disturbances, allergic reactions, mental changes, arrhythmias, cardiotoxicity

Hypersensitivity, G6PD deficiency, optic neuritis, tinnitus, pregnancy (relative contraindication), past adverse quinine reaction (continuous ECG, blood pressure [when drug is given IV], and glucose monitoring recommended), optic neuritis, tinnitus, pregnancy (relative contraindication), past adverse quinine reaction (continuous ECG, blood pressure [when drug is given IV], and glucose monitoring recommended)

QuinidineQuinidine

Arrhythmias, widened QRS complex, prolonged QTc interval, hypotension, hypoglycemia

Hypersensitivity, thrombocytopenia (continuous ECG, blood pressure, and glucose monitoring recommended)

No loading dose in patients receiving > 40 mg/kg of quinine in the preceding 48 hours or a dose of mefloquine in preceding 12 hoursNo loading dose in patients receiving > 40 mg/kg of quinine in the preceding 48 hours or a dose of mefloquine in preceding 12 hours

PrimaquinePrimaquine

Severe intravascular hemolysis in people with G6PD deficiency, gastrointestinal disturbances, leukopenia, methemoglobinuria

Concomitant use of quinacrine or potentially hemolytic or bone marrow suppressing agents, G6PD deficiency, pregnancy (because G6PD status of the fetus is unknown)

Pyrimethamine/sulfadoxine

Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal neurolysis, urticaria, exfoliative dermatitis, serum sickness, hepatitis, seizures, mental changes, gastrointestinal disturbances, stomatitis, pancreatitis, bone marrow toxicity, hemolysis, fever, nephrosis

Hypersensitivity, folate deficiency anemia, infants ≤ 2 months, pregnancy, breastfeeding

TafenoquineTafenoquine

Severe intravascular hemolysis in patients with G6PD deficiency, psychiatric reactions, methemoglobinemia, gastrointestinal disturbances, hypersensitivity reactions

G6PD deficiency, pregnancy (because G6PD status of the fetus is unknown), breastfeeding (unless child is known to have normal G6PD), psychotic disorder, known hypersensitivity

Children < 16 years