Treatment of severe malaria caused by Plasmodium falciparum in adults and children, administered intravenously, usually followed by oral consolidation therapy with a long-acting antimalarial.
Also known as: Artesunato injetável
WHO-prequalified model SmPC (MA152) and EMA (Artesunate Amivas).
WHO-prequalified model SmPC (MA152) and EMA (Artesunate Amivas).
Antimalarial + UGT inducer: rifampicin reduces active metabolite (DHA) levels.
Rifampicin induces UGT1A9, the enzyme that metabolises artesunate to dihydroartemisinin (DHA). Co-administration decreases AUC and peak plasma concentration of DHA, reducing antimalarial efficacy.
Parasite count, blood count, liver function.
Antimalarial treatment failure.
Avoid if possible. If necessary, consider doubling artesunate dose or monitor parasitaemia.
drugs.com; MedScape
Antimalarial + mixed enzyme inhibitor: ritonavir reduces DHA levels.
Ritonavir decreases AUC and peak plasma concentration of the active metabolite DHA, possibly via UGT induction or other metabolic pathways. Risk of antimalarial treatment failure.
Parasite count.
Antimalarial treatment failure.
Monitor parasitaemia frequently. Consider additional artesunate dose.
drugs.com; MedScape
Antimalarial + UGT inducer: phenytoin reduces DHA levels.
Phenytoin induces UGT, decreasing DHA AUC. Effect similar to rifampicin but less pronounced.
Parasite count, phenytoin levels.
Antimalarial treatment failure.
Monitor parasitaemia. Consider dose adjustment.
drugs.com; MedScape
Antimalarial + UGT inducer: carbamazepine reduces DHA levels.
Carbamazepine induces UGT, decreasing DHA AUC. Risk of antimalarial treatment failure in epileptic patients.
Parasite count, carbamazepine levels.
Antimalarial treatment failure.
Monitor parasitaemia. Consider additional artesunate dose.
drugs.com; MedScape
Antimalarial + UGT inducer: phenobarbital reduces DHA levels.
Phenobarbital induces UGT, decreasing DHA AUC. Effect similar to other enzyme inducers.
Parasite count, phenobarbital levels.
Antimalarial treatment failure.
Monitor parasitaemia. Consider additional dose.
drugs.com; MedScape
Antimalarial + enzyme inducer: nevirapine reduces DHA levels.
Nevirapine decreases DHA AUC, possibly via UGT and CYP enzyme induction. Relevant for HIV+ patients in Angola.
Parasite count, blood count.
Antimalarial treatment failure.
Monitor parasitaemia and HIV viral load.
drugs.com; MedScape
Antimalarial + antiepileptic: valproate may interact with artesunate metabolism.
Valproate may partially inhibit UGT, slightly increasing DHA levels. Clinically modest effect but worth monitoring.
Valproate levels, blood count.
Monitor valproate levels and signs of toxicity.
drugs.com
Antimalarial + antimetabolite: both affect blood count. Additive risk of myelosuppression.
Both can cause myelosuppression. The combination increases the risk of pancytopenia, especially with high-dose methotrexate.
Blood count, signs of infection.
Pancytopenia.
Monitor blood count weekly during concomitant treatment.
drugs.com
No direct interaction is known between artesunate and alcohol; caution is advised during malaria treatment.
Limit alcohol intake during treatment.
WHO-prequalified model SmPC (MA152) and EMA (Artesunate Amivas) — WHO Guidelines for malaria: https://www.who.int/teams/global-malaria-programme/guidelines-for-malaria
Artesunate (oral or injectable) can be given with or without food, with no relevant food interaction.
May be taken with or without food, consistently.
WHO-prequalified model SmPC (MA152) and EMA (Artesunate Amivas) — WHO Guidelines for malaria: https://www.who.int/teams/global-malaria-programme/guidelines-for-malaria
Data in severe hepatic impairment are limited; artesunate should be used with caution, with monitoring.
Use with caution in severe liver disease.
WHO-prequalified model SmPC (MA152) and EMA (Artesunate Amivas) — WHO Guidelines for malaria: https://www.who.int/teams/global-malaria-programme/guidelines-for-malaria
Artemisinin derivatives may slightly prolong the QT interval; use with caution in patients with QT prolongation or with QT-prolonging drugs.
Monitor ECG in at-risk patients.
WHO-prequalified model SmPC (MA152) and EMA (Artesunate Amivas) — WHO Guidelines for malaria: https://www.who.int/teams/global-malaria-programme/guidelines-for-malaria
Injectable artesunate is the drug of choice for severe malaria in pregnancy (all trimesters); the treatment benefit clearly outweighs the risk.
Use for severe malaria in pregnancy, in all trimesters, per WHO guidelines.
Excreted into breast milk in small amounts; compatible with breastfeeding under supervision.
No specific additional contraception.
WHO-prequalified model SmPC (MA152) and EMA (Artesunate Amivas) — WHO Guidelines for malaria: https://www.who.int/teams/global-malaria-programme/guidelines-for-malaria
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Artemisinin prodrug with rapid action on erythrocytic Plasmodium forms: the endoperoxide is activated by parasitic heme iron, generating free radicals that damage parasite proteins and membranes. It rapidly reduces parasitemia, including in severe malaria.
After intravenous administration, artesunate is rapidly hydrolyzed to the active metabolite dihydroartemisinin (DHA), an endoperoxide that, activated by intraparasitic iron, generates reactive species that damage parasite proteins and prevent multiplication.
Administered intravenously; artesunate is rapidly converted to DHA (conversion half-life of minutes), reaching therapeutic DHA concentrations immediately.
Artesunate is extensively metabolized by hydrolysis (plasma and hepatic esterases) to DHA, the main active metabolite; DHA is then glucuronidated and excreted in bile and urine.
Artesunate: elimination half-life 3–29 min; DHA: 40–95 min (WHO model SmPC, MA152).
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
