artemether-lumefantrine

REMS

Treatment of acute, uncomplicated malaria in patients ≥5 kg.
Not approved for severe/complicated Plasmodium falciparum malaria or prevention.

Contraindicated in:

Hypersensitivity to artemether or lumefantrine;
Known QTc prolongation, conditions or medications associated with QTc prolongation, hypokalemia, or hypomagnesemia;
Concurrent use of strong CYP3A4 inducers.

Use Cautiously in:

Severe hepatic/renal impairment;
Concurrent use of medications that are metabolized by CYP2D6 and/or also have cardiac effects;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children <5 kg (safety and efficacy not established);
Geri: Consider age-related decreased hepatic, renal, or cardiac function, and concomitant disease concurrent drug therapy.

Drug-drug:

Concurrent use with strong CYP3A4 inducers including rifampin, carbamazepine, or phenytoin, may ↓ levels and efficacy; concurrent use contraindicated
Concurrent use other antimalarials should be avoided due to lack of safety data.
Concurrent use with any other drugs that prolong QTc interval including quinine, class IA antiarrhythmics (quinidine, procainamide, disopyramide), class III antiarrhythmics (amiodarone, sotalol), antipsychotics (pimozide, ziprasidone); antidepressants; or certain anti-infectives (macrolides, fluoroquinolones, imidazoles/triazoles); should be avoided.
CYP3A4 inhibitors may ↑ levels and the risk of QT interval prolongation.
Effectiveness may be ↓ by mefloquine if used immediately before treatment (encourage food consumption).
May ↓ effectiveness of hormonal contraceptives (additional non-hormonal method of contraception should be used).
Concurrent use of antiretrovirals may ↑ risk of QTc prolongation, ↓ antiretroviral efficacy, or ↓ antimalarial efficacy.
Concurrent use of CYP2D6 substratesincluding flecainide, imipramine, amitriptyline and clomipramine may ↑ risk of adverse reactions and/or ↑ risk of QTc prolongation; avoid concurrent use.

Drug-Natural Products:

St. John's wort may ↓ concentrations; concurrent use contraindicated

Drug-Food:

Grapefruit juicemay ↑ blood levels and risk of QTc prolongation and should be avoided.

Tablets: artemether 20 mg/lumefantrine 120 mg

PO (Adults ≥35 kg): 4 tablets per dose for a total of 6 doses; given as two doses 8 hours apart on the first day, then twice daily for the next 2 days.
PO (Children 25 – <35 kg): 3 tablets per dose for a total of 6 doses; given as two doses 8 hours apart on the first day, then twice daily for the next 2 days.
PO (Children 15 – <25 kg): 2 tablets per dose for a total of 6 doses; given as two doses 8 hours apart on the first day, then twice daily for the next 2 days.
PO (Children 5 – <15 kg): 1 tablet per dose for a total of 6 doses; given as two doses 8 hours apart on the first day, then twice daily for the next 2 days.

Consists of a fixed ratio of 1:6 parts of artemether and lumefantrine, respectively. Artemether is a prodrug that is rapidly converted to dihydroartemisinin (DHA), its active metabolite. Both components inhibit nucleic acid and protein synthesis.

Therapeutic effects:

Antimalarial activity directed at the erythrocytic stages of Plasmodium falciparum.

Therapeutic Classification: antimalarials

Absorption: Well absorbed following oral administration, food increases absorption. Artemether is a prodrug that is rapidly converted to Dihydroartemisinin (DHA), an active antimalarial compound.

Distribution: Unknown.

Protein Binding: Lumefantrine: 99.7%.

Metabolism/Excretion: Extensively metabolized by the liver. Artemether is primarily metabolized by CYP3A4/5. Lumefantrine is metabolized mainly by CYP3A. Lumefantrine also significantly inhibits CYP2D6.

Half-Life: Artemether and DHA: 2 hr; lumefantrine: 3–6 days.

(antimalarial effect)

ROUTE	ONSET	PEAK‡	DURATION
artemether PO	unknown	2 hr	hrs
lumefantrine PO	unknown	6–8 hr	days

‡Blood levels.

Instruct patient to take medication as directed. Advise patient to resume eating as soon as food can be tolerated; improves absorption of medication. Advise patient to notify health care professional of flu-like symptoms (chills, fever, muscle pains, headache) occur again after finishing medication. Instruct patient to read Medication Guide before starting therapy and with each Rx refill in case of changes.
Advise patient to notify health care professional if they have taken other medications to treat malaria recently.
Advise patient to avoid drinking grapefruit juice during therapy; may cause increased concentrations and risk of arrhythmias.
May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
Advise patient to notify health care professional if symptoms of prolongation of the QT interval (prolonged heart palpitations, loss of consciousness) occur.
Instruct patient to notify health care professional immediately if signs of hypersensitivity (skin rash, hives, other skin reactions, rapid heartbeat, difficulty breathing or swallowing, swelling of the lips, tongue, face, tightness or throat, hoarseness) occur.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially St. John's Wort.
Review methods of minimizing exposure to mosquitoes with patient.
Rep: Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Medication may cause loss of pregnancy and decreased effectiveness of hormonal contraceptives; advise patient to use a non-hormonal form of birth control during therapy.

ar-te-METH-er loo-me-FAN-treen

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Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Classifications ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Pronunciation ⬆