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# Tavohep (Tafenoquine)
## Overview
Tavohep (tafenoquine) is an 8-aminoquinoline antimalarial and prophylactic agent. It is a prodrug that is converted to its active metabolite, which inhibits parasitic DNA replication.
## Primary Indications
* Treatment of acute malaria caused by *Plasmodium vivax* in patients 16 years of age and older.
* Prophylaxis against malaria caused by *Plasmodium falciparum* and *Plasmodium vivax*.
## Adult Dosing
**Treatment of *P. vivax* Malaria:**
* A single oral dose of 200 mg (base).
**Malaria Prophylaxis:**
* **Initiation:**
* 3 days before expected travel to a malaria-endemic area: 100 mg (base) orally once weekly.
* On the day of departure: 200 mg (base) orally once.
* **During Travel:**
* 100 mg (base) orally once weekly.
* **Post-Travel:**
* 70 mg (base) orally once weekly for 7 weeks.
## Pediatric Dosing
Tafenoquine is **not recommended** for use in pediatric patients for malaria prophylaxis due to insufficient data and increased risk of hemolysis in G6PD deficient individuals. For treatment of *P. vivax* malaria, it is approved in patients 16 years and older.
## Dose Adjustments
No dose adjustments are necessary for patients with hepatic or renal impairment.
## Contraindications
* Known hypersensitivity to tafenoquine or other 8-aminoquinolines.
* Severe G6PD deficiency (risk of acute hemolytic anemia). Screening for G6PD deficiency is required before initiation.
* Concomitant use of tafenoquine with other drugs known to induce hemolytic anemia.
## Adverse Effects
* **Common:** Headache, nausea, vomiting, diarrhea, dizziness, methemoglobinemia, rash.
* **Serious:** Acute hemolytic anemia (especially in G6PD deficient individuals), neuropsychiatric effects (anxiety, insomnia, vivid dreams), cardiac arrhythmias.
## Key Drug Interactions
* **G6PD-deficient individuals:** Increased risk of hemolysis when coadministered with drugs known to cause hemolysis.
* **CYP2D6 inhibitors:** May increase tafenoquine plasma concentrations.
## Monitoring
* **Before initiation:** Screen for G6PD deficiency.
* **During treatment/prophylaxis:** Monitor for signs and symptoms of hemolytic anemia (e.g., jaundice, dark urine, pallor, fatigue) and neuropsychiatric changes.
## Clinical Pearls
* Due to the long half-life of tafenoquine, it provides prolonged plasma concentrations, allowing for less frequent dosing compared to other antimalarials.
* The treatment regimen for *P. vivax* malaria addresses both the blood stage and the dormant liver stage (hypnozoites).
* Careful patient selection and G6PD testing are critical due to the risk of severe hemolysis.
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***Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making clinical decisions. Dosing and recommendations may vary based on local protocols and individual patient factors.*
