Glucose-6-Phosphate Dehydrogenase Deficiency and Primaquine Safety in Plasmodium vivax Elimination Programs
Winniefred Nankya
Department of Clinical Pharmacy Kampala International University Uganda
Email:winniefred.nankya@studwc.kiu.ac.ug
ABSTRACT
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzymatic disorder, affecting approximately 400 million individuals globally, with significant implications for malaria elimination strategies. Primaquine remained the only licensed antimalarial capable of eliminating Plasmodium vivax hypnozoites, yet its oxidative properties pose substantial risks to G6PD-deficient individuals. This review examined the biochemical mechanisms underlying primaquine-induced hemolysis in G6PD deficiency and evaluated current strategies for safe primaquine deployment in P. vivax elimination programs. A comprehensive literature review was conducted, analyzing peer-reviewed publications from 2010 to 2025, focusing on G6PD biochemistry, primaquine pharmacology, diagnostic approaches, and policy implementation in endemic regions. G6PD deficiency exhibited marked genetic heterogeneity with over 200 documented variants demonstrating variable enzymatic activity and clinical phenotypes. Primaquine metabolism generates oxidative metabolites that overwhelm the reduced antioxidant capacity in deficient erythrocytes, triggering acute hemolytic anemia. Novel point-of-care diagnostic technologies and modified dosing regimens, including weekly administration schedules, showed promise in balancing therapeutic efficacy with safety profiles across diverse G6PD phenotypes. Successful P. vivax elimination necessitated integration of accessible G6PD screening with tailored primaquine protocols, supported by enhanced pharmacovigilance systems and community education initiatives in endemic populations.
Keywords: Glucose-6-phosphate dehydrogenase deficiency, Primaquine safety, Plasmodium vivax elimination, Hemolytic anemia, Point-of-care diagnostics
CITE AS: Winniefred Nankya (2026). Glucose-6-Phosphate Dehydrogenase Deficiency and Primaquine Safety in Plasmodium vivax Elimination Programs. IAA Journal of Biological Sciences 14(1):65-74. https://doi.org/10.59298/IAAJB/2026/1416574