Artemether

Class

Sesquiterpene with an endoperoxide moeity

Antiparasitic Activity

Active against all human malarial parasites, including multi-drug resistant Plasmodium falciparum strains.

Mechanism of Action

Several proposed including the production of free radicals, other reactive metabolites, and altered membrane transport properties of membranes which may inhibit nutrient flow to the parasite.

Pharmacodynamics

No data available

Pharmacokinetics

3.4mg/kg dose in adult patients; Cmax: 689 mcg/L; Half-life: 4.2 hours; Table 4

Adverse Effects

Cardiac: QTc prolongation, bradycardia

Dosage

For both uncomplicated and severe falciparum malaria, the recommended dose schedule is 3.2 mg/kg on day 1, followed by 1.6 mg/kg daily for up to 7 days. An oral dose of approximately 2 mg/kg daily, for up to 7 days has also been suggested for the treatment of uncomplicated malaria.

For the combined artemether (20 mg)/ lumefantrine (120mg) tablet preparation, a dose of artemether (80 mg)/ lumefantrine (500 mg) given to adult patients (travellers returning to Europe after visiting tropical countries) at the time of diagnosis, and repeated at 6-8, 24 and 48 h is recommended.

For the treatment of patients who have no natural immunity, an adult dose of artemether 80 mg/ lumefantrine 500 mg given at the time of initial diagnosis, and repeated after 8, 24, 36, 48 and 60 h is suggested.

Children’s doses should be scaled appropriately as recommended in the manufacturer’s international product information.

Disease state based dosing

Renal failure: Although clearance decreases in patients with acute renal failure, overall the data suggest no dosage adjustment is necessary.

Hepatic Insufficiency: no data available

Contraindications/Warnings/Precautions

No data available

Drug Interactions

Varying reports on interactions with mefloquine (significant decrase in the AUC). Concomitant administration of ketoconazole and artemether resulted in an increased AUC of artemether.

Pregnancy

Not established. The World Health Organization currently advises against the use of artemisinins in the first trimester of pregnancy, unless in a lifesaving situation where other drugs are not suitable. In the second and third trimesters of pregnancy, artemisinin and its derivatives are not recommended unless alternative drug treatments are unsuitable.

Monitoring Requirements

None

Brand names/Manufacturer

PALUTHER (Aventis – BRAZIL, FRANCE)