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# Tabevol (Tafenoquine)
## Overview
Tafenoquine is an 8-aminoquinoline antimalarial drug used for the radical cure of *Plasmodium vivax* malaria and for malaria prophylaxis. It has a long half-life, allowing for less frequent dosing compared to other antimalarials.
## Primary Indications
* Radical cure (prevention of relapse) of *Plasmodium vivax* malaria in individuals aged 2 years and older who have already received a short-course treatment of a 7-day primaquine regimen.
* Malaria prophylaxis in individuals aged 2 years and older.
## Adult Dosing
* **Radical Cure of *P. vivax***: A single 200 mg dose.
* **Malaria Prophylaxis**:
* **Prevention of relapse**: 200 mg once weekly for 8 weeks, starting at least 7 days before travel and continuing for 7 days after leaving the endemic area.
* **Prevention of malaria illness**: 200 mg once weekly, starting 1 week before travel and continuing for 7 days after leaving the endemic area.
## Pediatric Dosing
* **Radical Cure of *P. vivax***: 200 mg as a single dose for patients aged 2 years and older.
* **Malaria Prophylaxis**:
* **Prevention of relapse**: 200 mg once weekly for 8 weeks, starting at least 7 days before travel and continuing for 7 days after leaving the endemic area.
* **Prevention of malaria illness**: 200 mg once weekly, starting 1 week before travel and continuing for 7 days after leaving the endemic area.
* Dosing for children under 12 years of age or weighing less than 45 kg should be based on weight: 5 mg/kg (maximum 200 mg).
## Dose Adjustments
No dose adjustments are typically required for hepatic or renal impairment. However, caution is advised in patients with severe hepatic or renal impairment due to limited data.
## Contraindications
* Known hypersensitivity to tafenoquine or other 8-aminoquinolines.
* Individuals with G6PD deficiency (risk of hemolytic anemia). A G6PD deficiency screening test is mandatory before initiating treatment.
* Individuals with an ongoing or recent history of P. falciparum malaria.
* Breastfeeding women when the infant is less than 2 months of age, or if the infant is less than 6 months of age and G6PD deficient.
## Adverse Effects
Common adverse effects include headache, nausea, vomiting, diarrhea, and dizziness.
Serious adverse effects can include hemolytic anemia (especially in G6PD deficient individuals), methemoglobinemia, and potential cardiac arrhythmias (QTc prolongation).
## Key Drug Interactions
* **CYP1A2 inhibitors**: Use with caution, as concomitant use may increase tafenoquine exposure.
* **CYP1A2 inducers**: May decrease tafenoquine exposure.
* **Drugs known to prolong the QTc interval**: Increased risk of cardiac arrhythmias.
## Monitoring
* **G6PD deficiency screening**: Essential before initiating therapy.
* **Hemoglobin and methemoglobin levels**: Monitor during treatment, especially in patients with risk factors.
* **ECG**: Consider monitoring for QTc prolongation, particularly in patients with risk factors for arrhythmias.
* **Signs and symptoms of hemolysis**: Monitor closely.
## Clinical Pearls
* Tafenoquine is a single-dose radical cure for *P. vivax*, simplifying treatment compared to 7-day primaquine regimens.
* It can be used for both prevention of relapse and prevention of malaria illness.
* Mandatory G6PD testing is crucial to avoid severe hemolytic anemia.
* Due to its long half-life, tafenoquine may still be present in the body for weeks or months after administration, requiring consideration for potential interactions or monitoring.
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*Disclaimer: This information is intended for clinical use and does not replace professional judgment. Always refer to the most current prescribing information and local protocols for definitive guidance.*
