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 "title": "Tafenoquine",
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 "excerpt": "Tafenoquine (Krintafel, Kozenis, Arakoda, Kodatef; WR 238605) is a long-acting 8-aminoquinoline antimalarial, a primaquine analogue discovered by the U.S. Army in 1978, FDA-approved in 2018 for weekly malaria prophylaxis and single-dose radical cure of Plasmodium vivax malaria, contraindicated in G6PD deficiency.",
 "snippet": "Tafenoquine (Krintafel, Kozenis, Arakoda, Kodatef; WR 238605) is a long-acting 8-aminoquinoline antimalarial, a primaquine analogue discovered by the U.S. Army in 1978, FDA-approved in 2018 for weekly malaria prophylaxis and single-dose radical cure of Plasmodium vivax malaria, contraindicated in G6PD deficiency.",
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 "markdown": "# Tafenoquine\n\n**Tafenoquine** is an orally active 8-aminoquinoline antimalarial drug, a long-acting analog of primaquine, sold as Krintafel, Kozenis, Arakoda, and Kodatef. It is active against the pre-erythrocytic (liver) and erythrocytic (asexual blood) forms and the gametocytes of *Plasmodium* species, including *Plasmodium vivax* and *Plasmodium falciparum*, and against the dormant liver stage (hypnozoite) of *P. vivax* that causes relapses<sup>[1](https://pubmed.ncbi.nlm.nih.gov/30229442/)</sup><sup> • </sup><sup>[2](https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210607lbl.pdf)</sup>. In 2018 it became the first 8-aminoquinoline registered by the U.S. [Food and Drug Administration](https://www.edgepedia.org/food-and-drug-administration) since primaquine, for two separate indications: prevention of malaria and radical cure (relapse prevention) of *P. vivax* malaria<sup>[3](https://journals.asm.org/doi/10.1128/cmr.00011-19)</sup>.\n\n| Key fact | Detail |\n|---|---|\n| Drug class | 8-aminoquinoline, long-acting primaquine analog; development code WR 238,605<sup>[1](https://pubmed.ncbi.nlm.nih.gov/30229442/)</sup><sup> • </sup><sup>[4](https://www.ncbi.nlm.nih.gov/books/NBK556584/?report=printable)</sup>  |\n| Discovery | 1978, Experimental Therapeutics division, Walter Reed Army Institute of Research<sup>[4](https://www.ncbi.nlm.nih.gov/books/NBK556584/?report=printable)</sup><sup> • </sup><sup>[5](https://www.army.mil/article/212996/usammda_celebrates_fda_approval_of_antimalarial_drug_tafenoquine)</sup>  |\n| U.S. approvals | July 2018, Krintafel 150 mg for radical cure of *P. vivax* malaria (age ≥16); August 2018, Arakoda 100 mg for prophylaxis (age ≥18)<sup>[6](https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6846a4-H.pdf)</sup> |\n| Half-life | Approximately 17 days, permitting weekly prophylactic dosing<sup>[7](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=299e49d8-470f-4779-a010-4a1ee0e0c6cd)</sup> |\n| Radical cure dose | Single 300 mg dose with chloroquine, versus primaquine 15 mg daily for 14 days<sup>[8](https://www.cochrane.org/evidence/CD010458_tafenoquine-preventing-relapse-people-vivax-malaria)</sup> |\n| Key safety limit | Contraindicated in G6PD deficiency or unknown G6PD status because of hemolytic anemia risk; G6PD testing required before prescribing<sup>[7](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=299e49d8-470f-4779-a010-4a1ee0e0c6cd)</sup> |\n| Prophylaxis efficacy | 200 mg weekly gave protective efficacy of 77.9–100% versus placebo in randomized trials, comparable to 250 mg weekly mefloquine<sup>[9](https://pubmed.ncbi.nlm.nih.gov/33227500/)</sup> |\n\n## Origin and development\n\nThe U.S. Army discovered tafenoquine in 1978 at the Walter Reed Army Institute of Research (WRAIR), during a search for a safer, more effective, and longer-acting replacement for primaquine<sup>[4](https://www.ncbi.nlm.nih.gov/books/NBK556584/?report=printable)</sup><sup> • </sup><sup>[5](https://www.army.mil/article/212996/usammda_celebrates_fda_approval_of_antimalarial_drug_tafenoquine)</sup>. Primaquine had been the antirelapse drug of choice in the United States since its FDA approval in 1952, but hemolysis in glucose-6-phosphate dehydrogenase (G6PD)-deficient individuals and limited blood-stage activity kept it from widespread use for prophylaxis<sup>[10](https://academic.oup.com/milmed/article/185/Supplement_1/617/5740680)</sup>. Of thousands of candidates screened at WRAIR, about 700 showed early promise, and compound WR 238,605 emerged as the frontrunner<sup>[10](https://academic.oup.com/milmed/article/185/Supplement_1/617/5740680)</sup>.\n\nAnimal work showed that tafenoquine had a significantly longer half-life than primaquine, allowing weekly instead of daily dosing, and activity against all lifecycle stages of the parasite<sup>[10](https://academic.oup.com/milmed/article/185/Supplement_1/617/5740680)</sup>. In 1988, WRAIR transferred development management to the U.S. Army Medical Materiel Development Activity (USAMMDA); the Investigational New Drug application was filed with the FDA in 1991, and the first-in-human study took place in Florida in 1992, followed by a controlled human malaria infection challenge study at WRAIR and field trials in Thailand and Kenya in 1996–1997<sup>[10](https://academic.oup.com/milmed/article/185/Supplement_1/617/5740680)</sup><sup> • </sup><sup>[11](https://pmc.ncbi.nlm.nih.gov/articles/PMC6750137/)</sup>.\n\nClinical development then proceeded in fits and starts for roughly three decades<sup>[12](https://pmc.ncbi.nlm.nih.gov/articles/PMC6243017/)</sup>. Renewed attention to *P. vivax* malaria in the last decade before approval, with commitment from the Bill and Melinda Gates Foundation, Medicines for Malaria Venture, and GlaxoSmithKline, helped carry the drug to registration<sup>[12](https://pmc.ncbi.nlm.nih.gov/articles/PMC6243017/)</sup>. The final prophylaxis dossier drew on more than 25 worldwide clinical trials with over 3,000 participants<sup>[10](https://academic.oup.com/milmed/article/185/Supplement_1/617/5740680)</sup>.\n\n## Regulatory approvals\n\nTwo U.S. approvals in 2018 covered distinct uses. In July 2018, the FDA approved Krintafel (tafenoquine 150 mg tablet, GlaxoSmithKline) for radical cure of *P. vivax* malaria in patients aged 16 years and older receiving appropriate antimalarial therapy for acute *P. vivax* infection<sup>[1](https://pubmed.ncbi.nlm.nih.gov/30229442/)</sup><sup> • </sup><sup>[6](https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6846a4-H.pdf)</sup>. In August 2018, the FDA approved Arakoda (tafenoquine 100 mg tablet, 60 Degrees Pharmaceuticals) for prophylaxis of malaria in patients aged 18 and older, for up to 6 months of continuous use<sup>[1](https://pubmed.ncbi.nlm.nih.gov/30229442/)</sup><sup> • </sup><sup>[4](https://www.ncbi.nlm.nih.gov/books/NBK556584/?report=printable)</sup>. The Australian Therapeutic Goods Administration followed in September 2018, with the brand pairs Krintafel/Kozenis and Arakoda/Kodatef<sup>[13](https://pmc.ncbi.nlm.nih.gov/articles/PMC6411314/)</sup>. The August prophylaxis approval was the first FDA-approved antimalarial prophylactic medication in 18 years<sup>[10](https://academic.oup.com/milmed/article/185/Supplement_1/617/5740680)</sup>.\n\n## Mechanism and pharmacology\n\nThe exact mechanisms of anti-*Plasmodium* activity are unknown. [In vitro](https://www.edgepedia.org/in-vitro) studies with erythrocytic forms of *P. falciparum* suggest tafenoquine may act by inhibiting hematin polymerization and by inducing apoptotic-like death of the parasite<sup>[2](https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210607lbl.pdf)</sup>. As an 8-aminoquinoline it is active against all stages of *Plasmodium* species, including the hypnozoite, the dormant liver stage that only drugs of this class clear<sup>[2](https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210607lbl.pdf)</sup>.\n\nThe long elimination half-life of approximately 17 days is the pharmacologic basis of both its weekly prophylactic regimen and its single-dose radical cure<sup>[7](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=299e49d8-470f-4779-a010-4a1ee0e0c6cd)</sup>. The same property means adverse reactions can be delayed in onset and duration<sup>[7](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=299e49d8-470f-4779-a010-4a1ee0e0c6cd)</sup>. Tafenoquine shows a dose-dependent effect on [QT interval](https://www.edgepedia.org/qt-interval) prolongation, but the proposed 300 mg clinical dose did not have a significant effect<sup>[14](https://www.accessdata.fda.gov/drugsatfda_docs/nda/2018/210795Orig1s000Admincorres.pdf)</sup>. The label advises avoiding co-administration with substrates of the organic cation transporter-2 (OCT2) or multidrug and toxin extrusion (MATE) transporters<sup>[7](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=299e49d8-470f-4779-a010-4a1ee0e0c6cd)</sup>.\n\n## Radical cure of P. vivax malaria\n\nThe approved radical cure regimen is a single 300 mg dose taken with the blood-stage treatment (chloroquine in the pivotal trials)<sup>[8](https://www.cochrane.org/evidence/CD010458_tafenoquine-preventing-relapse-people-vivax-malaria)</sup>. A Cochrane review of three randomized trials in 747 adults across nine countries found that tafenoquine 300 mg reduced *P. vivax* recurrences over six months compared with no antihypnozoite treatment (risk ratio 0.32, 95% CI 0.12 to 0.88) and showed probably little or no difference from standard-dose primaquine (15 mg/day for 14 days; risk ratio 1.04, 95% CI 0.8 to 1.34), with moderate-certainty evidence<sup>[8](https://www.cochrane.org/evidence/CD010458_tafenoquine-preventing-relapse-people-vivax-malaria)</sup>. Because true relapse cannot be distinguished from reinfection in endemic areas, the trials measured recurrences as a proxy<sup>[8](https://www.cochrane.org/evidence/CD010458_tafenoquine-preventing-relapse-people-vivax-malaria)</sup>.\n\nThe GATHER phase 3 trial, conducted at seven sites in Peru, Brazil, Colombia, Vietnam, and Thailand, compared single-dose tafenoquine with supervised 14-day primaquine in G6PD-normal patients. Freedom from recurrence at 6 months was 67.0% (95% CI 61.0 to 72.3) with tafenoquine versus 72.8% (95% CI 65.6 to 78.8) with primaquine; the prespecified noninferiority margin was not met (odds ratio for recurrence 1.81, 95% CI 0.82 to 3.96), although the investigators noted the 4 percentage-point difference may fall within acceptable clinical variability<sup>[15](https://pubmed.ncbi.nlm.nih.gov/30650326/)</sup><sup> • </sup><sup>[16](https://www.nejm.org/doi/pdf/10.1056/NEJMoa1802537?download=true)</sup>. Hemoglobin declines did not differ significantly between groups<sup>[15](https://pubmed.ncbi.nlm.nih.gov/30650326/)</sup>.\n\n## Prophylaxis\n\nFor prevention, the approved Arakoda regimen is 200 mg daily for 3 days before travel, 200 mg weekly while in the malarious area, and a single 200 mg terminal dose in the week after exit, taken with food<sup>[7](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=299e49d8-470f-4779-a010-4a1ee0e0c6cd)</sup>. A 2021 meta-analysis of nine randomized trials with 2,495 participants aged 12 to 60 found that 200 mg weekly tafenoquine and higher doses significantly reduced *Plasmodium* infection versus placebo and were comparable to 250 mg weekly mefloquine, with protective efficacy between 77.9 and 100% (total risk ratio 0.22, 95% CI 0.07 to 0.73)<sup>[9](https://pubmed.ncbi.nlm.nih.gov/33227500/)</sup>. An earlier double-blind trial in holoendemic western Kenya found protective efficacy of 86% (95% CI 73 to 93) for 200 mg daily for 3 days followed by 200 mg weekly, and 89% (95% CI 77 to 95) for the 400 mg weekly regimen, over up to 13 weeks<sup>[17](https://pubmed.ncbi.nlm.nih.gov/11700577/)</sup>. A systematic review of primary and terminal prophylaxis concluded tafenoquine is effective for both, and that primary prophylaxis may continue to protect against vivax relapse after exposure ends<sup>[18](https://pubmed.ncbi.nlm.nih.gov/31225623/)</sup>.\n\n## Safety\n\nLike other 8-aminoquinolines, tafenoquine causes hemolysis in G6PD-deficient individuals, so G6PD testing must be performed before prescribing, and the drug is contraindicated in G6PD deficiency or unknown G6PD status<sup>[7](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=299e49d8-470f-4779-a010-4a1ee0e0c6cd)</sup>. Use during pregnancy is not recommended because a G6PD-deficient fetus could develop hemolytic anemia, and breastfeeding is contraindicated when the infant is G6PD deficient or of unknown status<sup>[7](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=299e49d8-470f-4779-a010-4a1ee0e0c6cd)</sup>. Other contraindications are a history of psychotic disorders or current psychotic symptoms, and known hypersensitivity to tafenoquine or other 8-aminoquinolines<sup>[7](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=299e49d8-470f-4779-a010-4a1ee0e0c6cd)</sup>. Psychosis was reported in three patients with a history of psychosis or schizophrenia who received tafenoquine doses different from the approved regimen<sup>[7](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=299e49d8-470f-4779-a010-4a1ee0e0c6cd)</sup>. Asymptomatic methemoglobin elevations have been observed, and the most common adverse reactions at incidence of 1% or more include headache, dizziness, back pain, diarrhea, nausea, vomiting, and increased alanine aminotransferase<sup>[7](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=299e49d8-470f-4779-a010-4a1ee0e0c6cd)</sup>.\n\nThe prophylaxis meta-analysis found adverse events comparable in frequency and severity between tafenoquine and comparator arms, but identified reversible, asymptomatic vortex keratopathy in subjects with prolonged exposure, and a single serious event of decreased macular sensitivity<sup>[9](https://pubmed.ncbi.nlm.nih.gov/33227500/)</sup>. The Cochrane reviewers were uncertain whether tafenoquine causes more serious adverse events such as hemoglobin drops than placebo or primaquine, the most common serious event in the tafenoquine groups being a hemoglobin decline<sup>[8](https://www.cochrane.org/evidence/CD010458_tafenoquine-preventing-relapse-people-vivax-malaria)</sup>.\n\n## Place in malaria treatment\n\nTafenoquine's single-dose radical cure addresses a practical weakness of primaquine, whose 14-day course is difficult to complete; the Cochrane authors called single-day dosing a significant practical advantage without an overall increase in adverse events in nonpregnant, G6PD-normal adults<sup>[8](https://www.cochrane.org/evidence/CD010458_tafenoquine-preventing-relapse-people-vivax-malaria)</sup>. Tafenoquine has been studied and approved for use in children aged 16 years and older, but people with G6PD deficiency were excluded from the trials and the drug is contraindicated for them<sup>[8](https://www.cochrane.org/evidence/CD010458_tafenoquine-preventing-relapse-people-vivax-malaria)</sup>, and a phase 3 trial was planned to examine safety in G6PD heterozygous deficient females with 40 to 70% enzyme activity<sup>[14](https://www.accessdata.fda.gov/drugsatfda_docs/nda/2018/210795Orig1s000Admincorres.pdf)</sup><sup> • </sup><sup>[19](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5cf989d5-36f5-4561-a30b-9fcb9deb6b6a)</sup>. WRAIR research continues on the mechanisms of efficacy and toxicity of tafenoquine and related compounds, aiming at safer next-generation prophylactic drugs<sup>[10](https://academic.oup.com/milmed/article/185/Supplement_1/617/5740680)</sup>.\n\n## References\n\n1. [Tafenoquine: First Global Approval, AdisInsight (PubMed 30229442)](https://pubmed.ncbi.nlm.nih.gov/30229442/)\n2. [ARAKODA (tafenoquine) tablets, FDA prescribing information, 2018](https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210607lbl.pdf)\n3. [Baird JK. 8-Aminoquinoline Therapy for Latent Malaria. Clinical Microbiology Reviews, 2019](https://journals.asm.org/doi/10.1128/cmr.00011-19)\n4. [Tafenoquine, in Assessment of Long-Term Health Effects of Antimalarial Drugs When Used for Prophylaxis, National Academies (NCBI Bookshelf)](https://www.ncbi.nlm.nih.gov/books/NBK556584/?report=printable)\n5. [USAMMDA Celebrates FDA Approval of Antimalarial Drug Tafenoquine, U.S. Army](https://www.army.mil/article/212996/usammda_celebrates_fda_approval_of_antimalarial_drug_tafenoquine)\n6. [Guidance for Using Tafenoquine for Prevention and Antirelapse Therapy for Malaria, MMWR 2019](https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6846a4-H.pdf)\n7. [ARAKODA (tafenoquine) tablets, DailyMed full prescribing information](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=299e49d8-470f-4779-a010-4a1ee0e0c6cd)\n8. [Rodrigo C, Rajapakse S, Fernando D. Tafenoquine for preventing relapse in people with vivax malaria, Cochrane Database of Systematic Reviews 2020](https://www.cochrane.org/evidence/CD010458_tafenoquine-preventing-relapse-people-vivax-malaria)\n9. [Maier JD et al. Efficacy and safety of tafenoquine for malaria chemoprophylaxis (1998–2020): a systematic review and meta-analysis, Travel Medicine and Infectious Disease](https://pubmed.ncbi.nlm.nih.gov/33227500/)\n10. [Army Antimalarial Drug Development: An Advanced Development Case Study for Tafenoquine, Military Medicine](https://academic.oup.com/milmed/article/185/Supplement_1/617/5740680)\n11. [8-Aminoquinoline Therapy for Latent Malaria (PMC version)](https://pmc.ncbi.nlm.nih.gov/articles/PMC6750137/)\n12. [Tafenoquine for travelers' malaria: evidence, rationale and recommendations (PMC)](https://pmc.ncbi.nlm.nih.gov/articles/PMC6243017/)\n13. [Clinical utility of tafenoquine in the prevention of relapse of Plasmodium vivax malaria (PMC)](https://pmc.ncbi.nlm.nih.gov/articles/PMC6411314/)\n14. [FDA NDA administrative correspondence for tafenoquine (210795), 2018](https://www.accessdata.fda.gov/drugsatfda_docs/nda/2018/210795Orig1s000Admincorres.pdf)\n15. [Tafenoquine versus Primaquine to Prevent Relapse of Plasmodium vivax Malaria (GATHER), PubMed 30650326](https://pubmed.ncbi.nlm.nih.gov/30650326/)\n16. [Tafenoquine versus Primaquine to Prevent Relapse of Plasmodium vivax Malaria, New England Journal of Medicine](https://www.nejm.org/doi/pdf/10.1056/NEJMoa1802537?download=true)\n17. [A new primaquine analogue, tafenoquine (WR 238605), for prophylaxis against Plasmodium falciparum malaria, PubMed 11700577](https://pubmed.ncbi.nlm.nih.gov/11700577/)\n18. [Tafenoquine for primary and terminal prophylaxis of malaria in apparently healthy people: a systematic review, PubMed 31225623](https://pubmed.ncbi.nlm.nih.gov/31225623/)\n19. [DailyMed - KRINTAFEL- tafenoquine succinate tablet, film coated](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5cf989d5-36f5-4561-a30b-9fcb9deb6b6a)\n\n---\n*Topic: Encyclopedia › Life and health › Human health and medicine › Medicines and therapeutics › Anti-infective drugs and resistance › Antiviral, antifungal, and antiparasitic drugs › Non-artemisinin antimalarials*\n\n*Initially written Oct 21, 2026*\n\n*Copyright 2026 EdgeChat AI, a subsidiary of Biostate AI.*\n\nLicense: Edgepedia Community License 1.0, https://www.edgepedia.org/edgepedia/license\n",
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  "summary": "Free with credit, commercial use included. AI training is open to everyone. For other uses, organizations over USD 100M in revenue or 100M monthly users license separately.",
  "spdx": "LicenseRef-Edgepedia-Community-1.0"
 },
 "credit": "\"Tafenoquine\", Edgepedia (EdgeChat), https://www.edgepedia.org/tafenoquine. Edgepedia Community License 1.0.",
 "credit_md": "\"[Tafenoquine](https://www.edgepedia.org/tafenoquine)\", Edgepedia (EdgeChat), [https://www.edgepedia.org/tafenoquine](https://www.edgepedia.org/tafenoquine). [Edgepedia Community License 1.0](https://www.edgepedia.org/edgepedia/license).",
 "credit_html": "\"<a href=\"https://www.edgepedia.org/tafenoquine\">Tafenoquine</a>\", Edgepedia (EdgeChat), <a href=\"https://www.edgepedia.org/tafenoquine\">https://www.edgepedia.org/tafenoquine</a>. <a href=\"https://www.edgepedia.org/edgepedia/license\">Edgepedia Community License 1.0</a>.",
 "speakable": "Tafenoquine is a long-acting 8-aminoquinoline antimalarial, a primaquine analogue discovered by the U.S."
}
