Arakoda

Arakoda is a prescription medication used to prevent malaria in people 18 years and older.

Arakoda belongs to a group of drugs called antimalarials. It works by killing the organisms that cause malaria.

The medication comes in tablet form. Arakoda is taken by mouth once daily for 3 days prior to travel, then once a week and continuing during travel where malaria is common. Arakoda should be taken with food. Do not break, crush, or chew tablets. Swallow tablets whole.

Common side effects include headache, back pain, diarrhea, and dizziness. Do not drive or operate heavy machinery until you know how Arakoda affects you.

Arakoda is a prescription medicine used to help prevent malaria (a serious disease of the blood that is spread by infected mosquitos) in people 18 years of age and older.

• It is not known if Arakoda is safe and effective in children.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with Arakoda. See the “Arakoda Precautions” section.

Common side effects include:

• diarrhea
• headache
• back pain
• nausea
• vomiting 
• dizziness
• increased liver enzyme levels in your blood
• motion sickness
• insomnia
• depression
• abnormal dreams
• anxiety

Other side effects of Arakoda include eye problems. Some people who take Arakoda can have a problem with the cornea of the eye called vortex keratopathy. This problem can be seen during an eye exam. Vortex keratopathy does not cause vision problems and will usually go away after you stop taking Arakoda.

This is not a complete list of Arakoda side effects. Ask your doctor or pharmacist for more information. Inform your doctor if you have any side effect that bothers you or does not go away. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Tell your doctor if you take:   

• Any medication that include Organic Cation Transporter-2 (OCT2) and Multidrug and Toxin Extrusion (MATE) substrates such as Tikosyn (dofetilide) or Riomet (metformin)  

This is not a complete list of Arakoda drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with Arakoda including:

• Breakdown of red blood cells (hemolytic anemia). Arakoda can cause a breakdown of red blood cells (hemolysis) in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Your healthcare provider will test you for G6PD deficiency before you start taking Arakoda. Signs of hemolytic anemia may not happen right away (delayed reaction).Tell your healthcare provider or get emergency medical help right away if you develop signs of hemolytic anemia which include darkening of the urine, dizziness, confusion, feeling tired, light-headedness, or shortness of breath, pale skin or yellowing of the skin and whites of the eyes.

• Decrease of oxygen in your blood caused by a certain type of abnormal red blood cell (methemoglobinemia). Signs and symptoms of methemoglobinemia may not happen right away (delayed reaction). Get medical help right away if you have bluish coloring of the lips or skin, headache, fatigue, shortness of breath, or lack of energy.

• Mental health (psychiatric) symptoms. Sleep problems, depression, anxiety and psychosis have happened while taking Arakoda. Psychiatric symptoms may not happen right away (delayed reaction). Get emergency medical help right away if you develop hallucinations (seeing or hearing things that are really not there), delusions (false or strange thoughts or beliefs), or if you get confused or have problems thinking while taking Arakoda. Call your healthcare provider if you develop changes in your mood, anxiety, trouble sleeping (insomnia), or nightmares for 3 days or longer while taking Arakoda.

Do not take Arakoda if you:
• have G6PD deficiency.
• are breastfeeding a child known to have G6PD deficiency or breastfeeding a child that has not been tested for G6PD deficiency.
• have a history of psychotic disorders, or you currently have psychotic symptoms including hallucinations (seeing or hearing things that are not really there), delusions (false or strange thoughts or beliefs), or disorganized thinking or behavior.
• are allergic to tafenoquine, other 8-aminoquinolines, or any of the ingredients in Arakoda. Allergic reactions can happen after you take Arakoda. Signs and symptoms of an allergic reaction may not happen right away (delayed reaction). Get medical help right away if you have any signs or symptoms of an allergic reaction including:

• swelling of the face, lips, tongue or throat
• itching
• trouble breathing or wheezing
• vomiting
• fainting and feeling lightheaded
• rash
• hives

Arakoda can cause drowsiness. Do not drive or operate heavy machinery until you know how Arakoda affects you.

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Arakoda, there are no specific foods that you must exclude from your diet when receiving this medication. 

Before taking Arakoda, tell your doctor about all of your medical conditions. Tell your doctor if you:

• have nicotinamide adenine dinucleotide (NADH) reductase deficiency. People with NADH reductase deficiency have a higher risk for methemoglobinemia if they take ARAKODA.

• have or have had mental health problems.

• are pregnant or plan to become pregnant. ARAKODA can harm an unborn baby who has G6PD deficiency.

• are breastfeeding or plan to breastfeed.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.  

Tell your doctor if you are pregnant or plan to become pregnant.  

Arakoda can harm an unborn baby who has G6PD deficiency. You should not become pregnant during treatment with Arakoda. Females who are able to become pregnant should use effective birth control (contraception) during treatment with Arakoda. Talk with your healthcare provider about birth control methods that may be right for you. Your healthcare provider may suggest you take a pregnancy test before you start taking Arakoda. Tell your healthcare provider right away if you become pregnant or think you might be pregnant during treatment with Arakoda.

Tell your doctor if you are breastfeeding or plant to breastfeed. 

It is not known if Arakoda passes into breast milk. Your healthcare provider should check your child for G6PD deficiency before you start breastfeeding. If you know your child has G6PD deficiency, do not breastfeed during treatment with Arakoda and for 3 months after your last dose of Arakoda.

 Take Arakoda exactly as your healthcare provider tells you to take it.

Arakoda is given as 2 tablets that you will take together as a single dose. Each Arakoda tablet has 100 mg of tafenoquine.

• You will start taking Arakoda 3 days before you travel to a malaria area.

  • Take 2 tablets, 1 time each day for 3 days.

• You will continue to take Arakoda while you are in the malaria area.

  • Take 2 tablets, 1 time each week.

  • Start taking this dose of Arakoda 7 days after the last dose of Arakoda that you took before your travel to the malaria area.

• You will take your last dose of Arakoda after you leave the malaria area.

  • Take 2 tablets.

  • Take this dose of Arakoda 7 days after the last dose of Arakoda that you took while you were in the malaria area.

• Take Arakoda tablets whole. Do not break, crush, or chew the tablets before swallowing.

• Take Arakoda with food.

It is important that you take the full course of treatment with Arakoda. Do not stop taking Arakoda without first talking to your healthcare provider because the medicine may not work as well to prevent malaria. 

• If you miss 1 or 2 daily doses of Arakoda before your travel to the malaria area:

  • 1 daily dose: take 2 tablets (missed dose), and then continue to take your daily dose of Arakoda until you have taken a total of 3 daily doses before your travel to the malaria area. Start taking your weekly doses or Arakoda 1 week after your last daily dose.
  • 2 daily doses: take 2 tablets (missed dose), 1 time each day for 2 days in a row (consecutive days) so that you have taken a total of 3 daily doses before your travel to the malaria area. Start taking your weekly doses of Arakoda 1 week after your last daily dose.

• If you miss any weekly doses of Arakoda while you are in the malaria area:

  • 1 weekly dose: take 2 tablets, 1 time on any day up to the time of your next scheduled weekly dose.
  • 2 weekly doses: take 2 tablets, 1 time on any day before your next scheduled weekly dose.
  • 3 or more weekly doses: take 2 tablets, 1 time each day for 2 days up to the time of your next scheduled weekly dose.

  If you miss taking your last dose of Arakoda 7 days after the last dose of Arakoda you took while you were in the malaria area, take this last dose of Arakoda as soon as you remember.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The recommended dosage is:

Loading regimen for each of the 3 days before travel to an area where malaria is common: 200 mg (2 of the 100 mg tablets) once daily for 3 days.

Maintenance regimen while in the area where malaria is common: 200 mg (2 of the 100 mg tablets) once weekly – start 7 days after the last loading regimen dose.

Terminal prophylaxis regimen in the week following exit from the area where malaria is common: 200 mg (2 of the 100 mg tablets) one-time 7 days after the last maintenance dose.

If you take too much Arakoda, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

• Store Arakoda at room temperature between 68°F to 77°F (20°C to 25°C).

• Protect tablets from moisture.

Keep Arakoda and all medicines out of the reach of children.

This page was written by Wilson Chiu, PharmD Candidate 2020 | UT Austin College of Pharmacy