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# Arsil (Artemether/Lumefantrine)
## Overview
Arsil is a fixed-dose oral artemisinin-based combination therapy (ACT). It combines artemether (a rapidly acting artemisinin derivative) with lumefantrine (a long-acting aryl-amino alcohol) to provide rapid parasitic clearance and prevent the emergence of resistance.
## Primary Indications
Treatment of uncomplicated *Plasmodium falciparum* malaria.
## Adult Dosing
Standard regimen is six doses administered over 3 days (at 0, 8, 24, 36, 48, and 60 hours).
* **Patients ≥35 kg:** 80 mg artemether/480 mg lumefantrine per dose.
* **Total course:** 6 doses.
## Pediatric Dosing
Dosing is weight-based. Ensure strict adherence to the 6-dose schedule:
* **5 kg to <15 kg:** 20 mg/120 mg per dose.
* **15 kg to <25 kg:** 40 mg/240 mg per dose.
* **25 kg to <35 kg:** 60 mg/360 mg per dose.
* **≥35 kg:** Follow adult dosing.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No formal adjustments established; use with caution in severe impairment as lumefantrine is metabolized by the liver.
* **Vomiting:** If vomiting occurs within 30 minutes of dose administration, the dose must be repeated.
## Contraindications
* Known hypersensitivity to artemether or lumefantrine.
* Severe malaria (requires parenteral therapy).
* History of QT prolongation or congenital long QT syndrome.
* History of symptomatic arrhythmias or clinically relevant bradycardia.
* Use with strong CYP3A4 inhibitors (e.g., ketoconazole) or inducers (e.g., rifampin).
## Adverse Effects
* **Common:** Headache, dizziness, anorexia, fatigue, arthralgia, myalgia, and sleep disorders.
* **Serious:** QT interval prolongation, hypersensitivity reactions (including angioedema), and rare reports of serious hematological disturbances.
## Key Drug Interactions
* **QT Prolonging Agents:** Avoid concomitant use with drugs like halofantrine, quinidine, or certain antipsychotics.
* **CYP3A4 Substrates:** Lumefantrine is a substrate; monitor for reduced efficacy if used with moderate or strong enzyme inducers.
* **Hormonal Contraceptives:** May decrease efficacy of oral contraceptives; advise patients to use alternative barrier methods during treatment.
## Monitoring
* Monitor for signs of treatment failure (persistent fever or parasitemia).
* Consider ECG monitoring in patients with pre-existing cardiac conditions or those on other QT-prolonging medications.
* Advise patients to take doses with high-fat food (e.g., milk, butter, or porridge) to maximize absorption.
## Clinical Pearls
* **Absorption:** Bioavailability is significantly increased when taken *with* fat; ensure patients are instructed to consume food with each dose.
* **Adherence:** The 6-dose regimen is critical; missing doses significantly increases the risk of recrudescence.
* **Status of Infection:** Do not use for malaria prophylaxis.
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**Educational Disclaimer:** This information is for educational purposes only. Always consult current institutional guidelines, local malaria treatment protocols, and the official manufacturer's prescribing information before ordering or administering medications. Clinical judgment should prevail in individual patient cases.
