Artemether and Lumefantrine

💊 What is Artemether and Lumefantrine used for?

• •The label says Coartem is used to treat acute, uncomplicated malaria infections caused by Plasmodium falciparum in people 2 months of age and older who weigh at least 5 kg (about 11 pounds). The label says it has been shown to work in regions where resistance to chloroquine has been reported. The label also says Coartem is not approved for severe or complicated P. falciparum malaria, and it is not approved for preventing malaria.

How it works

The label says both ingredients are blood schizontocides, which means they act against the malaria parasite while it is in the blood.

How it is usually taken

• •The label says Coartem should be taken with food. It also says people with malaria often do not feel like eating, so they are encouraged to return to normal eating as soon as they can tolerate food, because this improves how the medicine is absorbed.
• •Treatment is a 3-day course. Doses are spread over the first three days, with a second dose about 8 hours after the first and then doses in the morning and evening on the following two days.
• •The number of tablets per dose depends on body weight (and age for children), as set by the prescriber. Follow the instructions from your prescriber or pharmacist.
• •The label says tablets can be crushed and mixed with a small amount of water for people who cannot swallow tablets, such as infants and young children. It advises giving food or drink (such as milk, formula, pudding, broth, or porridge) after the crushed dose whenever possible.
• •The label says that if vomiting happens within 1 to 2 hours after a dose, a repeat dose should be taken. If the repeat dose is also vomited, the label says the patient should be given an alternative antimalarial. Contact your prescriber or pharmacist if this happens.

Comes as

• •Tablets containing 20 mg of artemether and 120 mg of lumefantrine (20 mg/120 mg)
• •Yellow, round, flat tablets with beveled edges, scored on one side, imprinted with "N/C" on one side and "CG" on the other
• •Supplied in a bottle of 24 tablets

⚠️ Artemether and Lumefantrine side effects

🛑 Who should not take Artemether and Lumefantrine, and who should be careful

The label says not to take it if

• 🚨You are allergic to artemether, lumefantrine, or any of the ingredients in Coartem.
• 🚨You are taking rifampin, carbamazepine, phenytoin, or St. John's wort. The label says these are strong CYP3A4 inducers and should not be used with Coartem.
• 🚨You have known QT prolongation (such as congenital long QT syndrome), or a family history of congenital QT prolongation or sudden death. The label says Coartem should be avoided in these people.
• 🚨You have low potassium (hypokalemia) or low magnesium (hypomagnesemia). The label says Coartem should be avoided in these people.
• 🚨You have a history of symptomatic heart rhythm problems, clinically relevant slow heartbeat (bradycardia), or severe heart disease. The label says Coartem should be avoided in these people.
• 🚨The label says Coartem has not been approved for severe or complicated malaria or for preventing malaria.

Tell your doctor before taking it if

• •Tell your healthcare provider about all your medical conditions, including if you have heart disease or a family history of heart problems or heart disease.
• •Tell your provider if you have liver or kidney problems.
• •Tell your provider if you have recently taken other medicines used to treat malaria.
• •Tell your provider if you are pregnant or plan to become pregnant.
• •Tell your provider about all other medicines you take, especially medicines that can affect the heart rhythm (QT interval), and medicines that are broken down by the enzyme CYP2D6.
• •The label says that people with a personal or family history of QT prolongation, or with conditions such as low potassium (hypokalemia), slow heartbeat (bradycardia), or recent heart ischemia, should tell their doctor.

🔀 Artemether and Lumefantrine with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Strong CYP3A4 inducers such as rifampin, carbamazepine, phenytoin, and St. John's wort are contraindicated. The label says they can lower the levels of artemether and lumefantrine and reduce how well Coartem works.
• •Halofantrine should not be given within 1 month of Coartem because of possible added effects on the QT interval.
• •Other antimalarials should not be given with Coartem unless there is no other treatment option.
• •Quinine and quinidine should be used cautiously after Coartem, and the label advises ECG monitoring if these QT-prolonging drugs are medically required.
• •CYP3A4 inhibitors, including grapefruit juice and ketoconazole, should be used cautiously. The label says they may increase levels of the medicine and affect the QT interval.
• •Antiretroviral drugs should be used cautiously because they can change the levels of artemether and lumefantrine.
• •Mefloquine taken just before Coartem may lower lumefantrine levels. The label says patients should be monitored and encouraged to eat.
• •Hormonal contraceptives may be less effective with Coartem. The label advises using a non-hormonal method or adding a barrier method of birth control during treatment.
• •Drugs broken down by CYP2D6, such as flecainide, imipramine, amitriptyline, and clomipramine, should be avoided during treatment, according to the label.
• •Other QT-prolonging medicines, including certain antiarrhythmics, antipsychotics, antidepressants, and some antibiotics and antifungals, should be used with caution. Tell your provider about all medicines you take.

Alcohol and food

The label says Coartem should be taken with food. It also says eating normally as soon as possible helps the body absorb the medicine. The label does not give information about alcohol use.

🤰 Artemether and Lumefantrine in pregnancy and breastfeeding

Pregnancy

The label says published data have not established an association between artemether/lumefantrine use in pregnancy and major birth defects, miscarriage, or adverse maternal or fetal outcomes. The label also says the available studies cannot definitively establish the absence of risk. It explains that malaria during and after pregnancy increases the risk of serious problems, including maternal anemia, severe malaria, miscarriage, stillbirth, preterm delivery, and low birth weight. Tell your healthcare provider if you are pregnant or plan to become pregnant.

Breastfeeding

The label does not say.

🗓️ Storage, missed doses and taking too much

Storage

The label says to store Coartem at 20°C to 25°C (68°F to 77°F), with brief excursions permitted between 15°C and 30°C (59°F to 86°F). It says to keep it in a tight container.

If a dose is missed

The label does not say.

If too much is taken

The label says there is no information on overdoses of Coartem higher than the recommended doses. It says that if an overdose is suspected, treatment would be supportive and would include ECG (heart tracing) and blood electrolyte monitoring. Seek emergency medical help right away if an overdose is suspected.

🗒️ Questions to ask about Artemether and Lumefantrine

• Is my malaria the type that Coartem treats (Plasmodium falciparum, uncomplicated)?
• How many tablets will I take per dose, and when should I take them?
• What should I do if I vomit within 1 to 2 hours after a dose?
• Are any of my current medicines, including herbal products such as St. John's wort, safe to take with Coartem?
• Do I have any heart conditions or a family history of heart rhythm problems that could affect my treatment?
• What birth control method should I use during treatment?
• What symptoms should make me seek emergency care while I take this medicine?

❓ Artemether and Lumefantrine: frequently asked questions