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Abstract
The technical genesis and practice of 8-aminoquinoline therapy of latent malaria offer singular scientific, clinical, and public health insights. The 8-aminoquinolines brought revolutionary scientific discoveries, dogmatic practices, benign neglect, and, finally, enduring promise against endemic malaria. The clinical use of plasmochin-the first rationally synthesized blood schizontocide and the first gametocytocide, tissue schizontocide, and hypnozoitocide of any kind-commenced in 1926. Plasmochin became known to sometimes provoke fatal hemolytic crises. World War II delivered a newer 8-aminoquinoline, primaquine, and the discovery of glucose-6-phosphate dehydrogenase (G6PD) deficiency as the basis of its hemolytic toxicity came in 1956. Primaquine nonetheless became the sole therapeutic option against latent malaria. After 40 years of fitful development, in 2018 the U.S. Food and Drug Administration registered the 8-aminoquinoline called tafenoquine for the prevention of all malarias and the treatment of those that relapse. Tafenoquine also cannot be used in G6PD-unknown or -deficient patients. The hemolytic toxicity of the 8-aminoquinolines impedes their great potential, but this problem has not been a research priority. This review explores the complex technical dimensions of the history of 8-aminoquinolines. The therapeutic principles thus examined may be leveraged in improved practice and in understanding the bright prospect of discovery of newer drugs that cannot harm G6PD-deficient patients.
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Winn RT, Miller JAL, Meggitt SJ. Is chloroquine neuromyotoxicity in a patient with refractory discoid lupus erythematosus potentiated by concomitant use of mepacrine? Clin Exp Dermatol 2018; 43:927-928. [DOI: 10.1111/ced.13666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- R. T. Winn
- Royal Victoria Infirmary; Newcastle-Upon-Tyne Hospitals NHS Foundation Trust; Newcastle-Upon-Tyne NE1 4LP UK
| | - J. A. L. Miller
- Royal Victoria Infirmary; Newcastle-Upon-Tyne Hospitals NHS Foundation Trust; Newcastle-Upon-Tyne NE1 4LP UK
| | - S. J. Meggitt
- Royal Victoria Infirmary; Newcastle-Upon-Tyne Hospitals NHS Foundation Trust; Newcastle-Upon-Tyne NE1 4LP UK
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Affiliation(s)
- Edward A. Hartshorn
- Medical College Hospital and the Philadelphia College of Pharmacy and Science and University of Illinois, Evanston Hospital Association, Evanston, Ill
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Abstract
The medium of drug transfer is the water of plasma and extracellular fluid. Without complicating factors, the level of drug at a receptor site would be equal to that in the tissues and in plasma, and in dynamic equilibrium. Actually, almost all drugs are reversibly bound to proteins in plasma or tissue. The bound drug, often a high proportion of the total, acts as a reservoir, preventing wild fluctuations between ineffective and toxic levels of the biologically active unbound fraction. Displacement from a receptor site diminishes drug activity, but displacement from plasma or tissue proteins augments the effect by making more unbound drug available at the receptor site. Atropine has no intrinsic activity, but displaces acetylcholine or pilocarpine from receptors at para-sympathetic nerve endings. Similarly guanethidine competes with noradrenaline at sympathetic nerve endings, but in turn is displaced by amphetamine-like drugs. Many acidic drugs (phenylbutazone, sulfonamides, coumarin anticoagulants, salicylates, &c.) are highly bound to one or two sites on albumin molecules. When the limited carrying capacity of the plasma proteins is filled, any unbound surplus is usually soon metabolized or excreted, so the plasma level becomes restabilized. Meanwhile, however, there may be dramatic effects such as hypoglycemia, when sulfonamides are given to patients on tolbutamide, or bleeding when phenylbutazone is given to patients on warfarin. Although hormones, like thyroxine, insulin and cortisol, are carried by specific proteins, they too can be displaced. All the antirheumatic drugs so far examined have displaced cortisol and presumably driven it into tissues. This may be one mechanism of action. Possibly the sulfonylurea drugs act by displacing insulin from proteins in the pancreas, plasma or elsewhere.
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Affiliation(s)
- Bernard B Brodie
- Laboratory of Chemical Pharmacology, National Heart Institute, Bethesda, Maryland, USA
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Affiliation(s)
- Edward A Hartshorn
- Jefferson Medical College Hospital and the Philadelphia College of Pharmacy and Science, USA
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Myint HY, Berman J, Walker L, Pybus B, Melendez V, Baird JK, Ohrt C. Review: Improving the therapeutic index of 8-aminoquinolines by the use of drug combinations: review of the literature and proposal for future investigations. Am J Trop Med Hyg 2011; 85:1010-4. [PMID: 22144436 PMCID: PMC3225144 DOI: 10.4269/ajtmh.2011.11-0498] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 09/13/2011] [Indexed: 11/07/2022] Open
Abstract
Because 8-aminoquinolines affect critical survival stages of Plasmodium parasites, treatment and control of malaria could be markedly improved by more widespread use of these drugs; however, hemolytic toxicity, which is widely prevalent in G6PD-deficient patients, severely constrains this use. Primaquine was approved more than 50 years ago after extensive clinical testing. Review of the mid-20th century literature in the light of present understanding of pharmacokinetics and metabolism suggests that manipulation of these factors might dissociate 8-aminoquinoline efficacy from toxicity and lead to an improved therapeutic index.
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Affiliation(s)
- Hla Y Myint
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
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BISHOP A, McCONNACHIE EW. Pamaquin Resistance in a Strain of Plasmodium gallinaceum and its relationship to Other antimalarial Drugs. Parasitology 2009; 42:57-64. [PMID: 14929561 DOI: 10.1017/s0031182000084274] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
1. A four- to eight-fold increase in resistance to pamaquin has been developed in a strain of Plasmodium gallinaceum in chicks.2. Pamaquin resistance conferred no resistance to proguanil, sulphadiazine, mepacrine, chloroquine or sontochin, but it conferred some resistance to pentaquine and to quinine.3. An appreciable loss in resistance to pamaquin was observed in the pamaquin-resistant strain after it had been maintained in the absence of the drug, in a patent state of infection, for a period of 6 months.4. No synergism was observed between pamaquin and quinine when these drugs were tested, in combined doses, upon active infections of P. gallinaceum.
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Earle DP, Bigelow FS, Zubrod CG, Kane CA. STUDIES ON THE CHEMOTHERAPY OF THE HUMAN MALARIAS. IX. EFFECT OF PAMAQUINE ON THE BLOOD CELLS OF MAN. J Clin Invest 2006; 27:121-9. [PMID: 16695624 PMCID: PMC438900 DOI: 10.1172/jci101950] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- D P Earle
- Department of Medicine, New York University College of Medicine, New York City
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Jones R, Pullman TN, Whorton CM, Craige B, Alving AS, Eichelberger L. THE THERAPEUTIC EFFECTIVENESS OF LARGE DOSES OF PALUDRINE IN ACUTE ATTACKS OF SPOROZOITE-INDUCED VIV AX MALARIA (CHESSON STRAIN). J Clin Invest 2006; 27:51-5. [PMID: 16695634 PMCID: PMC438889 DOI: 10.1172/jci101971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- R Jones
- Malarial Research Unit, Department of Medicine, University of Chicago
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Endoh YS, Yoshimura H, Sasaki N, Ishihara Y, Sasaki H, Nakamura S, Inoue Y, Nishikawa M. High-performance liquid chromatographic determination of pamaquine, primaquine and carboxy primaquine in calf plasma using electrochemical detection. JOURNAL OF CHROMATOGRAPHY 1992; 579:123-9. [PMID: 1447338 DOI: 10.1016/0378-4347(92)80370-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A high-performance liquid chromatographic method with electrochemical detection is described for quantification of pamaquine, primaquine and carboxy primaquine in calf plasma. After the proteins had been precipitated with acetonitrile, the drugs were separated on a 5-microns C18-modified polymer gel column with an isocratic mobile phase. The detection limit was 0.01 microgram/ml in plasma for all three compounds. The applicability of the method in pharmacokinetic studies was demonstrated by determining the plasma concentrations of the three substances in calves administered a single dose of pamaquine or primaquine.
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Affiliation(s)
- Y S Endoh
- National Veterinary Assay Laboratory, Ministry of Agriculture, Forestry and Fisheries, Tokyo, Japan
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Abstract
For the past 300 years antimalarial dosage regimens have not been based on pharmacokinetic information. However, now that this information is available, it is appropriate to examine current recommendations for prophylaxis and treatment. In healthy subjects, the cinchona alkaloids (quinine and quinidine), primaquine and proguanil (chloroguanide) are all rapidly eliminated with half-lives (t1/2 beta) of between 6 and 12 hours. Hepatic biotransformation accounts for approximately 80, 96 and 50% of their total clearance, respectively. In malaria, the pharmacokinetic properties of quinine and quinidine are significantly altered with a decrease in the apparent volume of distribution (Vd), prolongation of the elimination half-life, and a reduction in systemic clearance (CL) that is proportional to the severity of infection. Red cell concentrations and plasma protein binding are both increased in severe disease. Parenteral quinine or quinidine should be given by slow intravenous infusion rather than by intravenous or intramuscular injection, and a loading dose is necessary in severe infections. Chloroquine (t1/2 beta 6 to 50 days) and mefloquine (t1/2 beta 6.5 to 33 days) have extensive tissue distribution and prolonged activity after a single dose. Both drugs are concentrated in erythrocytes and 55% of chloroquine and 98% of mefloquine in plasma is bound to protein. The pharmacokinetics of chloroquine are complex and, because of the extremely long beta phase, difficult to accurately define. Pyrimethamine (t1/2 35 to 175 hours) has more limited tissue distribution, plasma and erythrocyte concentrations are similar, and 85% of the drug in plasma is bound to plasma proteins. The clearance of quinine, mefloquine and pyrimethamine appears to be higher in children than in adults. Currently, most of the information available on disposition of antimalarial drugs in humans is derived from studies in healthy adult subjects. More information is required on their pharmacokinetics in malaria, pregnancy, and in young children.
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Bhat BK, Seth M, Bhaduri AP. Recent developments in 8-aminoquinoline antimalarials. PROGRESS IN DRUG RESEARCH. FORTSCHRITTE DER ARZNEIMITTELFORSCHUNG. PROGRES DES RECHERCHES PHARMACEUTIQUES 1984; 28:197-231. [PMID: 6207558 DOI: 10.1007/978-3-0348-7118-1_6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Pirson P, Steiger R, Trouet A. The disposition of free and liposomally encapsulated antimalarial primaquine in mice. Biochem Pharmacol 1982; 31:3501-7. [PMID: 7150371 DOI: 10.1016/0006-2952(82)90633-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Plasma clearance, urinary excretion and tissue distribution of radiolabeled free (FPQ) and liposome-entrapped Primaquine (LPQ) in mice were monitored for 2 hr following intravenous administration. FPQ is eliminated very rapidly from the plasma and excreted predominantly in the urine, probably largely in a metabolized form. In decreasing order of magnitude, pronounced accumulation of label occurs in the liver, kidneys, lungs and skeletal muscle. Less than 1 per cent of the total initial dose is recovered in other tissues. Partial erythrocytic sequestration results in drug levels higher and more persistent in blood cells than in the plasma. Compared to the free drug form, Primaquine entrapped within negatively charged liposomes of the cholesterol-rich multilamellar type exhibits a prolonged plasmatic half-life and, within the observation period, excretion is 8-fold reduced. Liver accumulation of label is doubled, accounting for close to 50% of the injected dose; splenic uptake is tripled, while accumulation in the lungs, kidneys, heart and brain is drastically reduced. These differences in pharmacodynamic behaviour may explain why liposomal entrapment leads to diminished acute Primaquine toxicity.
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Fletcher KA, Evans DA, Gilles HM, Greaves J, Bunnag D, Harinasuta T. Studies on the pharmacokinetics of primaquine. Bull World Health Organ 1981; 59:407-12. [PMID: 6976848 PMCID: PMC2396059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A sensitive and specific assay for primaquine in plasma and urine using gas chromatography/mass spectrometry has been developed and used to study the plasma kinetics of primaquine. Preliminary studies on the effects of single and multiple oral doses have been carried out. In both cases the drug was completely, or almost completely, removed from the plasma in 24 h. The concentration of primaquine in the plasma usually reached a peak 1-2 hours after oral administration. The plasma elimination half-life was about 4 h. Less than 1% of the dose was detected in the urine collected over a 24-h period following drug ingestion. When Caucasian volunteers were given primaquine and chloroquine concurrently, some of them developed significant methaemoglobinaemia. Primaquine was not detectable in the plasma of any of the volunteers, 24 h after each daily dose.
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Greaves J, Evans DA, Gilles HM, Fletcher KA, Bunnag D, Harinasuta T. Plasma kinetics and urinary excretion of primaquine in man. Br J Clin Pharmacol 1980; 10:399-404. [PMID: 6934796 PMCID: PMC1430082 DOI: 10.1111/j.1365-2125.1980.tb01777.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
1 The kinetics of primaquine have been studied in twenty volunteers after single and multiple dose regimes. 2 The kinetic parameters were similar in glucose-6-phosphate dehydrogenase (G6PD) normal Thais, G6PD deficient Thais and in Caucasians. 3 The Caucasian subjects showed about 1% of the dose was excreted in the urine. 4 The kinetic parameters obtained from multiple dose studies in Thais were very similar to those obtained from single dose studies in Thais.
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Morrelli HF, Melmon KL. The clinician's approach to drug interactions. Calif Med 1968; 109:380-9. [PMID: 4881984 PMCID: PMC1503319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Drug interactions are important causes of both unexpected toxic and therapeutic effects. Adverse reactions due to drug interaction are proportional to the number of drugs given and the duration of administration. Although drug interactions may be beneficial, they are most often recognized when they increase mortality or morbidity. The frequency of adverse drug interactions in clinical practice makes it mandatory for physicians to know the drugs and mechanisms involved.A drug may potentiate or antagonize the effects of another drug by direct chemical or physical combination, by altering gastrointestinal absorption, by influencing metabolism, transport, or renal clearance, by changing the activity of a drug at its receptor site, or by modifying the patient's response to the drug by a variety of means. This article stresses the importance of avoiding multible drug therapy. When such treatment is unavoidable, patients must be carefully observed for evidence of intensified or diminished drug effect. Only this permits the detection and prevention of untoward drug interactions.
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Dayton PG, Perel JM, Landrau MA, Brand L, Mark LC. The relationship between binding of thiopental to plasma and its distribution into adipose tissue in man, as measured by a spectrophotofluorometric method. Biochem Pharmacol 1967; 16:2321-36. [PMID: 6075394 DOI: 10.1016/0006-2952(67)90219-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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BRODIE BB, COSMIDES GJ. Toxicology and the Biomedical Sciences: New programs are recommended for increasing research and training in toxicology and pharmacology. Science 1965; 148:1547-54. [PMID: 14287599 DOI: 10.1126/science.148.3677.1547] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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FAIRLEY NH. THE CHEMOPROPHYLAXIS AND CHEMOTHERAPY OF MALARIA IN MAN WITH SPECIAL REFERENCE TO THE LIFE CYCLE. AUSTRALASIAN ANNALS OF MEDICINE 1952; 1:7-17. [PMID: 14934611 DOI: 10.1111/imj.1952.1.1.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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COOPER WC. Summary of antimalarial drugs. PUBLIC HEALTH REPORTS (WASHINGTON, D.C. : 1896) 1949; 64:717-732. [PMID: 18149805 PMCID: PMC1996975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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