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Key Facts
- Drug Class
- Antimalarial (Antifolate)
- Prescription
- Over the counter
- NAFDAC Status
- NAFDAC Registered
- Forms
- Tablet
- Price Range
- ₦150 - ₦1,200
- WHO Essential
- Yes
What is Sulfadoxine-Pyrimethamine?
Sulfadoxine-Pyrimethamine (commonly called SP or by its famous brand name Fansidar) is an antimalarial drug that plays a unique and very important role in Nigeria's fight against malaria. Unlike Artemether-Lumefantrine or Artesunate, SP is not used for treating malaria once you have it. Instead, its primary role is in malaria prevention, particularly for two of the most vulnerable groups: pregnant women and young children. SP works by blocking two key enzymes that the malaria parasite needs to make folic acid, which is essential for the parasite to reproduce. It combines two antifolate drugs, sulfadoxine and pyrimethamine, to attack this process at two different points.
In Nigeria, SP is best known as the drug given to pregnant women during antenatal care (ANC) visits at hospitals and clinics. This programme, called Intermittent Preventive Treatment in pregnancy (IPTp), involves giving pregnant women at least three doses of SP during pregnancy, starting from the second trimester, with each dose given at least one month apart during scheduled ANC visits. Malaria in pregnancy is particularly dangerous in Nigeria because it can cause severe anaemia in the mother, low birth weight babies, premature delivery, and even death of the mother or baby. The IPTp programme has been a cornerstone of Nigeria's malaria control strategy and is provided free of charge at most government health facilities.
SP is also used in Seasonal Malaria Chemoprevention (SMC), a programme in northern Nigeria and other Sahel region countries where SP is given together with amodiaquine to children aged 3 to 59 months during the peak malaria transmission season (usually July to October). This has been shown to reduce malaria episodes in young children by up to 75%. It is important to understand that SP should NOT be used to treat an active malaria infection. If you have fever and suspect malaria, you need an ACT like Artemether-Lumefantrine, not SP.
What is Sulfadoxine-Pyrimethamine used for?
In Nigeria, Sulfadoxine-Pyrimethamine is commonly used for:
- Intermittent Preventive Treatment in pregnancy (IPTp) to prevent malaria during pregnancy
- Seasonal Malaria Chemoprevention (SMC) in children aged 3-59 months during peak malaria season
- Intermittent Preventive Treatment in infants (IPTi) alongside routine vaccinations
- NOT for treatment of acute or clinical malaria (use ACTs for treatment)
Dosage
IMPORTANT
Always follow your doctor's or pharmacist's instructions. The information below is for general reference only.
Adults
For IPTp in pregnancy: 3 tablets (each containing 500mg sulfadoxine/25mg pyrimethamine) as a single dose taken under observation during ANC visits. At least 3 doses should be given during pregnancy, starting from the second trimester (after the first 13 weeks), with each dose at least 4 weeks apart. The tablets should be taken with water, and the woman should remain at the facility for at least 15-30 minutes to ensure the dose is not vomited.
Children
For Seasonal Malaria Chemoprevention (SMC): Given with amodiaquine over 3 days during peak malaria months. SP dosing by age: 3-11 months: half tablet as a single dose on Day 1. 12-59 months: 1 tablet as a single dose on Day 1. Amodiaquine is given alongside on Days 1, 2, and 3. This is repeated monthly for 3-4 months during the rainy season.
SP must NOT be given in the first trimester of pregnancy (first 13 weeks) due to the risk of birth defects. It should also not be given to women who are HIV-positive and taking cotrimoxazole (Septrin) prophylaxis, as both drugs are antifolates and combining them increases the risk of severe side effects. SP is given as directly observed therapy (DOT), meaning the healthcare worker watches the woman swallow the tablets at the health facility to ensure compliance. Do not use SP if you are allergic to sulfa drugs.
Side Effects
Common side effects
- •Nausea and mild stomach discomfort
- •Headache
- •Dizziness
- •Mild skin rash or itching
- •Loss of appetite
Serious side effects — seek medical help immediately
- Stevens-Johnson Syndrome (severe blistering of the skin, mouth, and eyes - a medical emergency)
- Toxic Epidermal Necrolysis (widespread skin peeling - life-threatening)
- Severe allergic reaction (difficulty breathing, facial swelling)
- Blood disorders (agranulocytosis, thrombocytopenia, megaloblastic anaemia)
- Liver damage (hepatitis with jaundice)
- Kidney damage (crystalluria, renal failure)
When to see a doctor
Seek immediate medical attention if you develop any skin rash, blistering, or peeling of the skin after taking SP, as this could be a sign of Stevens-Johnson Syndrome, which is a medical emergency. Also see a doctor if you experience fever, sore throat, mouth ulcers, unusual bruising or bleeding, dark urine, yellowing of the eyes, or severe abdominal pain. Although serious reactions are rare, they can be life-threatening and require urgent treatment.
Warnings & Precautions
Do not take Sulfadoxine-Pyrimethamine if you have:
- Known allergy to sulfonamides (sulfa drugs) or pyrimethamine
- First trimester of pregnancy (risk of neural tube defects)
- Severe liver or kidney disease
- Blood disorders such as megaloblastic anaemia due to folate deficiency
- HIV-positive patients on cotrimoxazole (Septrin/Bactrim) prophylaxis
- Premature infants or neonates in the first weeks of life
Drug interactions
- •Cotrimoxazole (Septrin/Bactrim): MUST NOT be combined due to overlapping antifolate effects and increased toxicity risk
- •Folic acid (high-dose, 5mg): may reduce SP effectiveness. Use 0.4mg folic acid during pregnancy, not 5mg, when taking SP
- •Methotrexate: increased antifolate toxicity when combined
- •Warfarin: SP may increase the anticoagulant effect of warfarin
- •Phenytoin: increased risk of phenytoin toxicity
- •Zidovudine (AZT): increased risk of bone marrow suppression
Pregnancy & Breastfeeding
SP is specifically used FOR pregnant women as part of the IPTp programme, but it must only be given from the second trimester onwards (after 13 weeks of pregnancy). It should NEVER be given in the first trimester due to the risk of birth defects, particularly neural tube defects. An important note: pregnant women taking SP for IPTp should take only low-dose folic acid (0.4mg), not the high-dose 5mg folic acid tablet, as high-dose folic acid can interfere with the antimalarial action of SP. SP passes into breast milk in small amounts but is generally considered safe during breastfeeding. However, it should not be given to very young infants directly.
NAFDAC-Registered Brands of Sulfadoxine-Pyrimethamine in Nigeria
3 brands registered with NAFDAC as of 2026-02-01.
| Brand Name | Manufacturer | Strength | Form | NAFDAC Reg. No. |
|---|---|---|---|---|
| Fansidar | Roche | 500mg/25mg | Tablet | A4-0567 |
| Malareich | Swiss Pharma Nigeria | 500mg/25mg | Tablet | A4-2289 |
| Maloxine | Danadams Pharmaceutical | 500mg/25mg | Tablet | B4-3456 |
How to Verify Your Sulfadoxine-Pyrimethamine is Genuine
- 1Check the NAFDAC registration number on the pack. Genuine brands include Fansidar (A4-0567), Malareich (A4-2289), and Maloxine (B4-3456). Verify the number on the NAFDAC website or at a NAFDAC office.
- 2Scratch the NAFDAC Mobile Authentication Service (MAS) code if present on the pack and send the code via SMS to the number indicated to confirm authenticity.
- 3SP used in government IPTp and SMC programmes is typically supplied through official channels. If receiving SP at a government hospital or clinic during ANC visits, it should be genuine as it is procured through verified supply chains.
- 4If buying from a pharmacy, ensure the pharmacy is licensed and the product has clear packaging with manufacturer details, batch number, and expiry date.
- 5Be cautious of loose tablets sold without original packaging. SP should come in its original blister pack with full labelling.
Sulfadoxine-Pyrimethamine Price in Nigeria
Sulfadoxine-Pyrimethamine prices in Nigeria typically range from ₦150 to ₦1,200 per pack, depending on the brand, strength, and where you buy it.
₦150 – ₦1,200
per pack
Prices vary by location and vendor. Last updated: 2026-02-01
Where to Buy
Purchase Sulfadoxine-Pyrimethamine only from licensed pharmacies and verified distributors. Avoid buying medicines from unverified sources, roadside vendors, or unregistered market stalls.
Frequently Asked Questions
Sources
- •NAFDAC Greenbook — National Agency for Food and Drug Administration and Control registered products database
- •WHO Model List of Essential Medicines (23rd List, 2023)
- •British National Formulary (BNF)
- •Nigerian Standard Treatment Guidelines