Artemether + Lumefantrine Pharmacology

Artemether + Lumefantrine

About Artemether + Lumefantrine
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Mechanism of Action of Artemether + Lumefantrine
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Pharmacokinets of Artemether + Lumefantrine
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Onset of Action for Artemether + Lumefantrine
N/A
Duration of Action for Artemether + Lumefantrine
N/A
Half Life of Artemether + Lumefantrine
N/A
Side Effects of Artemether + Lumefantrine
1.Fever
2.Cough
3.Vomiting
4.Headache
5.Dizziness
6.Anorexia
7.Tinnitus
8.Tremor
9.Palpitation
10.Vertigo
11.Gastrointestinal disorders
12.Itch
13.Nasopharyngitis
14.Potentially fatal:Anaphylactic reactions.
Contra-indications of Artemether + Lumefantrine
1.Severe malaria according to the World Health Organisation (WHO) definition, eg malaria affecting the brain, or causing pulmonary oedema or kidney failure.
2.History of an abnormal heart rhythm, present from birth, seen on a heart monitoring trace (ECG) as a 'prolonged QT interval'.
3.History of irregular arrhythmias
4.Bradycardia
5.Heart failure
6.Disturbances in the levels electrolytes in the blood, eg: hypokalaemia or hypomagnesaemia
Special Precautions while taking Artemether + Lumefantrine
1.Severely decreased kidney function.
2.Severely decreased liver function.
3.Heart disease.
4.Should be taken with or after food
5.Avoid drinking grapefruit juice while taking this medicine
6.This medicine may cause fatigue and dizziness. Care to be taken performing potentially hazardous activites
Pregnancy Related Information
Contraindicated in first trimestes,
Use with caution in late trimesters
Old Age Related Information
N/A
Breast Feeding Related Information
Contraindicated
Children Related Information
N/A
Indications for Artemether + Lumefantrine
Treatment of uncomplicated Plasmodium falciparum malaria in adults, children and infants weighing 5kg and above.
Interactions for Artemether + Lumefantrine
1.It is recommended that artemether-lumefantrine not be administered concurrently with other antimalarials.
2.Mefloquine administration may reduce bile production, resulting in a reduction in the absorption of lumefantrine by 30 to 40%.
3.Artemether-lumefantrine should not be used concurrently with other drugs known to prolong the QTc interval.
4.It should be used with caution in patients taking drugs metabolized by CYP2D6 or drugs that act as a substrate, inhibitor, or inducer of CYP3A4.


Typical Dosage for Artemether + Lumefantrine
(Tablet containing 20 mg artemether and 120 mg lumefantrine)
Treatment with artemether-lumefantrine consists of a six-dose regimen given over 3 days, with doses based on patient age and weight (described below)

1.Adults and children > 35 kg or 12 Years
Four tablets are given as a single dose at the time of diagnosis, followed by four tablets 8 hours later, and then four tablets twice daily for 2 days (a total of 24 tablets over 3 days).

2.Infants and Children < 35 kg or 12 Years

5?14 kg One tablet is given at diagnosis, another tablet 8 hours later, and then 1 tablet twice daily for 2 days (a total of 6 tablets over 3 days).

15?24 kg Two tablets are given at diagnosis, another two tablets 8 hours later, and then two tablets twice daily for 2 days (a total of 12 tablets over 3 days).

25?34 kg Three tablets are given at diagnosis, another three tablets 8 hours later, and then three tablets twice daily for 2 days (a total of 18 tablets over 3 days).
Schedule of Artemether + Lumefantrine
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Storage Requirements for Artemether + Lumefantrine
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture.


Effects of Missed Dosage of Artemether + Lumefantrine
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Effects of Overdose of Artemether + Lumefantrine
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Artemether

About Artemether
It is a derivative of artemesinin. Methylether of dihydroartemisinin, a novel sesquiterpene lactone very rapid schizontocidal, used to treat fever and malaria.
Mechanism of Action of Artemether
It is a schizonticidal drug. The endoperoxide bridges in Artemether are cleaved by the binding of haeme and liberate highly active free radicals. These radicals bind to membrane proteins and cause lipid peroxidation and damages endoplasmic reticulum. It also inhibits protein synthesis and lysis of the parasite.
Pharmacokinets of Artemether
Absorption: Artemether is orally well absorbed. Distribution: It is distributed in plasma protein bound form. Metabolism: It is metabolised in the liver to active dihydro artemisnin
Onset of Action for Artemether
N/A
Duration of Action for Artemether
N/A
Half Life of Artemether
45 minutes
Side Effects of Artemether
1.Nausea
2.Vomiting
3.Diarrhoea
4.Abdominal pain
5.Tinnitus
6.Reduction in reticulocyte and leucocytes count
7.Dizziness
8.Bradycardia
9.Pain at the site of injection

Contra-indications of Artemether
1.Hypersensitivity to Artemether and other Artemisnin derivatives
Special Precautions while taking Artemether
1.Renal impairment
2.Hepatic impairment
3.Cardiac failure
4.Monitor patients on concomitant use of drugs which cause prolongation of QT intervals
Pregnancy Related Information
Use with caution
First trimester: contraindicated
Old Age Related Information
Use with caution
Breast Feeding Related Information
Contraindicated
Children Related Information
N/A
Indications for Artemether
1.Multi drug resistant Malaria
2.Ceribral Malaria
3.Chloroquine resistant Malaria
Interactions for Artemether
Erythromycin, terfenadine, astemizole, quinidine, amiodarone, disopyramide, bretylium, bearidil, sotalol, TCAs should be avoided.
Typical Dosage for Artemether
Adult(IM)80 mg twice daily for 1 day followed by 80 mg once daily for 4 days
Maximum dose: 480 mg for 5 days
Children (IM): 3.2 mg/kg body weight /day in 2 divided dose followed by 1.6 mg / kg body weight / day once daily for 4 days
Maximum dose: 9.6 mg / kg for 5 days
Schedule of Artemether
H
Storage Requirements for Artemether
Store at 15-30 degree C in a tightly closed container. Protect from heat and moisture.
Effects of Missed Dosage of Artemether
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Artemether
Give supportive measures and symptomatic treatment. Drug can be removed from the body by gastric lavage or by inducing emesis. Absorption of the drug can be reduced by administration of activated charcoal. Excretion of the drug can be enhanced by administration of sodium bicarbonate. Haemodialysis can be done in emergency conditions.

Lumefantrine

About Lumefantrine
Lumefantrine is an antimalarial agent used to treat acute uncomplicated malaria. It is administered in combination with artemether for improved efficacy. Lumefantrine is a racemic mixture of a synthetic fluorine derivative and is structurally related to quinine, mefloquine, and halofantrine.
Mechanism of Action of Lumefantrine
It interferes with the conversion of heme, the toxic intermediate step produced during hemoglobin break-down, to non-toxic hemozoin. Accumulation of heme and free radicals results in parasite death.
Pharmacokinets of Lumefantrine
1.Absorption:Food increases absorption
2.Distribution: Protein binding 99.7% bound
3.Metabolism:Extensively metabolized in the liver primarily by cytochrome P450 3A4. The major metabolite found in plasma is desbutyl-lumefantrine.

Onset of Action for Lumefantrine
N/A
Duration of Action for Lumefantrine
N/A
Half Life of Lumefantrine
~4.5 days
Side Effects of Lumefantrine
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Contra-indications of Lumefantrine
N/A
Special Precautions while taking Lumefantrine
N/A
Pregnancy Related Information
N/A
Old Age Related Information
N/A
Breast Feeding Related Information
N/A
Children Related Information
N/A
Indications for Lumefantrine
1.Lumefantrine and artemether combination therapy is indicated for the treatment of acute uncomplicated malaria caused by Plasmodium falciparum, including malaria acquired in chloroquine-resistant areas.
2.May also be used to treat uncomplicated malaria when the Plasmodium species has not been identified. Indicated for use in adults and children greater than 5 kg.

Interactions for Lumefantrine
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Typical Dosage for Lumefantrine
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Schedule of Lumefantrine
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Storage Requirements for Lumefantrine
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Effects of Missed Dosage of Lumefantrine
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Effects of Overdose of Lumefantrine
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