antibioticsbooks

262 PART 6 Antiparasitic Drugs
ability of the malaria parasite to detoxify hemoglobin
metabolites. Primaquine appears to affect
parasitic mitochondrial function.
Spectrum
Protozoa (activity variable by region): Plasmodium
falciparum, P. malariae, P. ovale, P. vivax
Like-a-parasite-but-technically-a-fungus: Pneumocystis
jirovecii (primaquine)
Adverse Effects
Cardiovascular: The quinolines can cause doserelated
cardiovascular toxicity, including QT
interval prolongation, hypotension, and potentially
fatal ventricular arrhythmias. Quinidine
is a class IA antiarrhythmic, and it is also used
therapeutically in the treatment of some arrhythmias
(however, like many antiarrhythmics, it
can be proarrhythmic). Cardiovascular effects
are most likely with IV quinidine; less common
with quinine, mefloquine, and chloroquine; and
rare with primaquine.
Hematologic: Primaquine can cause hemolysis in
patients deficient in glucose-6-phosphate dehydrogenase
(G6PD); testing for G6PD deficiency
is required before use.
Metabolic: Quinidine and quinine can cause profound
hypoglycemia resulting from the stimulated
release of insulin.
Psychiatric: Mefloquine is associated with a range
of psychiatric disturbances ranging from
insomnia, vivid dreams, and mood swings to
depression, psychosis, and suicide. Although
mefloquine is well tolerated by the vast