Primaquine is the only drug available for use as anti-relapse antimalarial for prophylactic in P.vivax malaria. However, this drug is not without side effects and most commonly cited effect is methaemoglobinaemia in patients with G6PD deficiency. Higher doses of primaquine cause methaemoglobinaemia in most subjects and leukopenia in some. However, there is a small fraction of black population with G6PD deficiency who develop anaemia due to intravascular haemolysis at daily dose levels of 15 mg (base) and above.

It is being increasingly felt that the eroding efficacy of commonly used antimalarials has contributed substantially to the resurgency of malaria during last three decades. Although new antimalarials have appeared in the market during this time but none has yet supplemented chloroquine. There are no drugs in the market at any cost or in advanced development that appear to be as well tolerated as chloroquine.

Combinations of existing antimalarials especially those now available in rural clinics and market hold great potential for effective, self administered therapies for uncomplicated malaria particularly where relapses are frequently encountered. Applying combined therapies to the problem should demand a high standard of proof of safety and efficacy in randomised double blind, placebo controlled trials.

The Central Drug Research Institute has developed a compound - given in house number "Compound 80/53" and allotted International Nonproprietary Name (INN) as Bulaquin - which is a primaquine derivative.

Bulaquin is without any side effects observed with primaquine. Comparative data on initial (0 day pre drug) and final (+7 day post drug) values of haemoglobin, methaemoglobin, prothrombin time, partial thromboplastin time and fibrinogen in healthy human subject treated with primaquine (15 mg OD x7 days) and Bulaquin (25 mg OD x7 days) have shown that one week primaquine treatment leads to rise in methaemoglobin levels from 3.97% to 16.32%, which is highly significant in comparison to the 2.29% and 3.02% levels of methaemoglobin before and after 7 days treatment with Bulaquin respectively. Thus, it is evident that primaquine treatment produces rise in methaemoglobin. While Bulaquine does not produce rise in methaemoglobin levels offering an advantage over primaquine.

Bulaquin has been licenced to Nicholas Piramal India Ltd., Mumbai for marketing . Nicholas Piramal has introduced Bulaquin alongwith chloroquine into the market as a combination pack under the trade name Aablaquine. The objective of the combined therapy is to control P.vivax malaria more effectively by providing initial cure and thereafter preventing relapses by use of this combination pack. It is hoped that the introduction of this combination pack of Bulaquin should contribute substantially to the ongoing National Malaria action programme advocated by Government of India.