For a radical cure, primaquine [unlicensed] is then given to
children over 6 months of age; specialist advice should be
sought for children under 6 months of age.
Parenteral
If the child is unable to take oral therapy, quinine can be
given by intravenous infusion, changed to oral chloroquine
as soon as the patient’s condition permits.
Pregnancy
Treatment doses of chloroquine can be given for non-
falciparum malaria. In the case ofP. vivaxorP. ovale,
however, the radical cure with primaquine should be
postponeduntil the pregnancy is over; instead chloroquine
should be continued, given weekly, during the pregnancy.
ANTIPROTOZOALS›ANTIMALARIALS
Artemether with lumefantrine
lINDICATIONS AND DOSE
Treatment of acute uncomplicated falciparum malaria|
Treatment of chloroquine-resistant non-falciparum
malaria
▶BY MOUTH
▶Child (body-weight 5–14 kg):Initially 1 tablet, followed
by 1 tablet for 5 doses each given at 8 , 24 , 36 , 48 , and
60 hours (total 6 tablets over 60 hours)
▶Child (body-weight 15–24 kg):Initially 2 tablets, followed
by 2 tablets for 5 doses each given at 8 , 24 , 36 , 48 , and
60 hours (total 12 tablets over 60 hours)
▶Child (body-weight 25–34 kg):Initially 3 tablets, followed
by 3 tablets for 5 doses each given at 8 , 24 , 36 , 48 , and
60 hours (total 18 tablets over 60 hours)
▶Child 12–17 years (body-weight 35 kg and above):Initially
4 tablets, followed by 4 tablets for 5 doses each given at
8 , 24 , 36 , 48 , and 60 hours (total 24 tablets over
60 hours)lUNLICENSED USEUse in treatment of non-falciparum
malaria is an unlicensed indication.
lCONTRA-INDICATIONSFamily history of congenital QT
interval prolongation.family history of sudden death.
history of arrhythmias.history of clinically relevant
bradycardia.history of congestive heart failure
accompanied by reduced left ventricular ejection fraction
lCAUTIONSAvoid in Acute porphyrias p. 603 .electrolyte
disturbances
lINTERACTIONS→Appendix 1 : antimalarials
lSIDE-EFFECTS
▶Common or very commonAbdominal pain.appetite
decreased.arthralgia.asthenia.cough.diarrhoea.
dizziness.headache.myalgia.nausea.palpitations.QT
interval prolongation.skin reactions.sleep disorders.
vomiting
▶UncommonClonus.drowsiness
▶Frequency not knownAngioedema
lPREGNANCYToxicity inanimalstudies with artemether.
Manufacturer advises use only if potential benefit
outweighs risk.
lBREAST FEEDINGManufacturer advises avoid
breastfeeding for at least 1 week after last dose. Present in
milk inanimalstudies.
lHEPATIC IMPAIRMENTManufacturer advises caution in
severe impairment.
lRENAL IMPAIRMENTManufacturer advises caution in
severe impairment.
MonitoringIn severe renal impairment monitor ECG and
plasma potassium concentration.
lMONITORING REQUIREMENTSMonitor patients unable to
take food (greater risk of recrudescence).
lDIRECTIONS FOR ADMINISTRATIONTablets may be crushed
just before administration.
lPATIENT AND CARER ADVICE
Driving and skilled tasksDizziness may affect performance
of skilled tasks (e.g. driving).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
CAUTIONARY AND ADVISORY LABELS 21
▶Riamet(Novartis Pharmaceuticals UK Ltd)
Artemether 20 mg, Lumefantrine 120 mgRiamet tablets|
24 tabletP£ 22. 50Artenimol with piperaquine
phosphate
(Piperaquine tetraphosphate with
dihydroartemisinin)lINDICATIONS AND DOSE
Treatment of uncomplicated falciparum malaria
▶BY MOUTH
▶Child 6 months–17 years (body-weight 7–12 kg): 0. 5 tablet
once daily for 3 days, max. 2 courses in 12 months;
second course given at least 2 months afterfirst course
▶Child 6 months–17 years (body-weight 13–23 kg): 1 tablet
once daily for 3 days, max. 2 courses in 12 months;
second course given at least 2 months afterfirst course
▶Child 6 months–17 years (body-weight 24–35 kg): 2 tablets
once daily for 3 days, max. 2 courses in 12 months;
second course given at least 2 months afterfirst course
▶Child 6 months–17 years (body-weight 36–74 kg): 3 tablets
once daily for 3 days, max. 2 courses in 12 months;
second course given at least 2 months afterfirst course
▶Child 6 months–17 years (body-weight 75–99 kg): 4 tablets
once daily for 3 days, max. 2 courses in 12 months;
second course given at least 2 months afterfirst courselCONTRA-INDICATIONSAcute myocardial infarction.
bradycardia.congenital long QT syndrome.electrolyte
disturbances.family history of sudden death.heart failure
with reduced left ventricular ejection fraction.history of
symptomatic arrhythmias.left ventricular hypertrophy.
risk factors for QT interval prolongation.severe
hypertension
lINTERACTIONS→Appendix 1 : antimalarials
lSIDE-EFFECTS
▶Common or very commonAbdominal pain.anaemia.
appetite decreased.asthenia.conjunctivitis.cough.
diarrhoea.eosinophilia.fever.increased risk of infection.
leucocytosis.leucopenia.neutropenia.QT interval
prolongation.skin reactions.thrombocytopenia.
vomiting
▶UncommonArthralgia.cardiac conduction disorder.
epistaxis.headache.hepatic disorders.hypochromia.
lymphadenopathy.nausea.rhinorrhoea.seizure.
splenomegaly.stomatitis.thrombocytosis
lPREGNANCYTeratogenic inanimalstudies—manufacturer
advises use only if other antimalarials cannot be used.
lBREAST FEEDINGManufacturer advises avoid—present in
milk inanimalstudies.
lHEPATIC IMPAIRMENTNo information available in
moderate to severe impairment.
MonitoringManufacturer advises monitor ECG and
plasma-potassium concentration in moderate to severe
hepatic impairment.
lRENAL IMPAIRMENTNo information available in moderate
to severe impairment.BNFC 2018 – 2019 Malaria 393
Infection5