Artemether + Lumefantrine is a fixed-dose combination therapy commonly used to treat uncomplicated malaria caused by Plasmodium falciparum. As a cornerstone of artemisinin-based combination therapies (ACTs), it is endorsed by the World Health Organization and included on its List of Essential Medicines.
Artemether + Lumefantrine: Combination Therapy for Malaria
What’s in the Combination?
- Artemether:
- Derived from artemisinin, a compound from the sweet wormwood plant.
- Rapidly clears parasites from the bloodstream.
- Has a short half-life (about 1–2 hours), making it fast-acting.
- Lumefantrine:
- A synthetic compound structurally related to older antimalarials.
- Works more slowly but remains in the body longer (half-life: 3–6 days).
- Clears any remaining parasites and helps prevent relapse or resistance.
How It Works
- Artemether: Destroys parasites by generating toxic free radicals that damage cell membranes and essential proteins.
- Lumefantrine: Interferes with parasite metabolism by binding to heme, disrupting nucleic acid and protein synthesis.
Indications for Use
- Specifically used for acute, uncomplicated malaria caused by P. falciparum.
- Often prescribed in regions with chloroquine resistance.
Dosing Guidelines
- Standard regimen: 6 doses taken over 3 days.
- Adults & children ≥35 kg: 4 tablets per dose (each tablet contains 20 mg artemether + 120 mg lumefantrine).
- Children <35 kg: Dose is adjusted by weight.
- Must be taken with a fatty meal or milk to improve lumefantrine absorption.
Possible Side Effects
- Common:
- Headache
- Nausea and vomiting
- Abdominal discomfort
- Dizziness
- Fatigue.
- Rare but Serious:
- QT interval prolongation (can cause heart rhythm disturbances)
- allergic reactions including rash or swelling.
Contraindications & Cautions
- Known hypersensitivity to either component.
- Severe malaria (requires injectable treatment).
- Heart rhythm issues, especially prolonged QT interval.
- Liver or kidney dysfunction.
- Pregnancy, especially during the first trimester (unless no alternatives exist).
Drug Interactions
- Inhibitors of CYP3A4 (e.g., ketoconazole, protease inhibitors): May raise lumefantrine levels.
- Inducers of CYP3A4 (e.g., rifampin, carbamazepine): Can reduce the drug’s effectiveness.
- Other QT-prolonging drugs (e.g., macrolides, antipsychotics): May increase risk of cardiac side effects.
Important Takeaways
- Effective against chloroquine-resistant strains of P. falciparum.
- Should not be used for malaria prevention (prophylaxis).
- Combining artemether with lumefantrine reduces resistance risk.
- Proper adherence and dietary intake are key for effectiveness.