Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: A Study of the Pharmacokinetics of Primaquine in Lactating Women and Breastfed Infants for the Radical Treatment of Uncomplicated Maternal P. Vivax
Brief Summary: The weight of malaria falls most heavily on young children and pregnant women but studies of the safety of antimalarials in pregnancy and lactation are few. The only recommended medication used for radical treatment of P.vivax is primaquine. The 2010 WHO malaria guidelines recommend its use in all patients with P.vivax infection in areas of low transmission, in the absence of contraindications. Primaquine is contraindicated in pregnancy. The postpartum period presents a key opportunity to definitively treat women who suffer multiple malaria relapses during pregnancy. The 2010 WHO malaria treatment guidelines allow for primaquine use during lactation but there are no studies to date quantifying primaquine excretion in breast milk and the dose that breastfed infants would be exposed to is unknown. The investigators propose to study the pharmacokinetics of primaquine in maternal and infant plasma and in breast milk during a 14 day radical treatment of P.vivax.

Some inferences about the expected behavior of primaquine in lactation can be drawn from its known pharmacologic properties. Primaquine pharmacokinetics have been well characterized in healthy subjects and malaria patients after single and multiple oral dosing. Peak concentrations are reached within 2-3 hours after dosing and the plasma elimination half-life is \~7 hours. It is extensively distributed in the tissue and largely metabolized to inert carboxyprimaquine, the major plasma metabolite, which undergoes further biotransformation to unknown metabolites that are probably more toxic than the parent compound. The identification of other metabolites in humans has been difficult to pursue because the expected aminophenol metabolites are unstable.

No pharmacokinetic studies have been done to measure primaquine excretion in breast milk. A few studies have been done of other antimalarials during lactation and have shown low levels of drug in breast milk during treatment.


Options:
A: Intervention Type: DRUG; Name: primaquine; Assigned to Arm(s): N/A
B: Arm Label: Primaquine; Type: EXPERIMENTAL; Interventions: Drug: Primaquine | Intervention Type: DRUG; Name: Primaquine; Assigned to Arm(s): Primaquine
C: Arm Label: Artesunate; Type: ACTIVE_COMPARATOR; Interventions: Drug: Artesunate | Arm Label: Chloroquine; Type: ACTIVE_COMPARATOR; Interventions: Drug: Chloroquine | Arm Label: Chloroquine/Primaquine; Type: EXPERIMENTAL; Interventions: Drug: Chloroquine/Primaquine | Intervention Type: DRUG; Name: Artesunate; Assigned to Arm(s): Artesunate | Intervention Type: DRUG; Name: Chloroquine; Assigned to Arm(s): Chloroquine | Intervention Type: DRUG; Name: Chloroquine/Primaquine; Assigned to Arm(s): Chloroquine/Primaquine
D: Arm Label: Cohort 1 Tafenoquine; Type: EXPERIMENTAL; Interventions: Drug: Tafenoquine | Arm Label: Cohort 1-Chloroquine; Type: ACTIVE_COMPARATOR; Interventions: Drug: Chloroquine + Primaquine | Arm Label: Cohort 2 Tafenoquine; Type: EXPERIMENTAL; Interventions: Drug: tafenoquine | Arm Label: Cohort 2 Chloroquine; Type: ACTIVE_COMPARATOR; Interventions: Drug: Chloroquine + Primaquine | Intervention Type: DRUG; Name: Tafenoquine; Assigned to Arm(s): Cohort 1 Tafenoquine | Intervention Type: DRUG; Name: Chloroquine + Primaquine; Assigned to Arm(s): Cohort 1-Chloroquine | Intervention Type: DRUG; Name: tafenoquine; Assigned to Arm(s): Cohort 2 Tafenoquine | Intervention Type: DRUG; Name: Chloroquine + Primaquine; Assigned to Arm(s): Cohort 2 Chloroquine

Answer: B