The potential nephrotoxic effect of single tablet of 15 mg primaquine in G6PD deficient Hadoti region population of India

Primaquine is used in prevention of relapse of plasmodium vivax and ovale. It is known to cause haemolysis induced acute kidney injury in patients with glucose-6-phosphate dehydrogenase (G-6-PD) enzyme deficiency. Primaquine is widely used in the remote areas of Hadoti region of India by many non-registered practitioners for treatment of febrile illnesses without prior testing of G-6-PD status. Due to this practice, many patients land up with the grave consequences with significant health care burden. We report 8 such cases, which were referred to our hospital, New hospital medical college, Kota, Rajasthan, India. Our study included a series of 8 cases which were referred to our hospital with significantly deranged renal function test due to use of primaquine without prior testing of G-6-PD status. Routine blood investigations including renal function tests and G-6-PD status were measured. In our study, we found that patients with febrile illness and G-6-PD deficiency developed acute kidney injury even with a single tablet of 15 mg of primaquine. The use of even a single dose of 15 mg primaquine may not be safe in population of Hadoti region of India. Hence they should not be exposed to primaquine without prior G-6-PD testing.