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# Arsil (Artemether/Lumefantrine) ## Overview Artemether/lumefantrine is a fixed-dose combination fixed-ratio antimalarial. Artemether provides rapid reduction in parasite biomass, while lumefantrine serves to eliminate residual parasites and prevent recrudescence. ## Primary Indications Treatment of uncomplicated *Plasmodium falciparum* malaria. Not indicated for prophylaxis or for the treatment of severe/complicated malaria. ## Adult Dosing Standard regimen is six doses over three days: * **Patients ≥35 kg:** 4 tablets per dose (80 mg artemether/480 mg lumefantrine) at 0, 8, 24, 36, 48, and 60 hours. * **Total course:** 24 tablets. ## Pediatric Dosing Dosing is weight-based (6-dose regimen over 3 days): * **5 kg to <15 kg:** 1 tablet (20 mg/120 mg) per dose. * **15 kg to <25 kg:** 2 tablets (20 mg/120 mg) per dose. * **25 kg to <35 kg:** 3 tablets (20 mg/120 mg) per dose. * **≥35 kg:** Use adult dosing (4 tablets per dose). ## Dose Adjustments * **Renal/Hepatic Impairment:** No specific guidelines; use with caution in severe cases due to lack of pharmacokinetic data. * **Vomiting:** If the patient vomits within 30 minutes of administration, the dose must be repeated. If within 30-60 minutes, repeat half the dose. ## Contraindications * Known hypersensitivity to artemether or lumefantrine. * Severe malaria (requires parenteral therapy). * History of QTc interval prolongation or cardiac arrhythmias. * Concomitant use of strong CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin). ## Adverse Effects * **Common:** Headache, dizziness, anorexia, nausea, vomiting, abdominal pain, arthralgia, myalgia, and fatigue. * **Serious:** QTc prolongation (rare but significant), hypersensitivity reactions, and potential for delayed hemolytic anemia. ## Key Drug Interactions * **QT-prolonging agents:** Avoid concomitant use with class IA/III antiarrhythmics, antipsychotics, or macrolide antibiotics. * **CYP3A4 Inhibitors/Inducers:** Strong inducers decrease efficacy (avoid). Strong inhibitors (e.g., ketoconazole) may increase lumefantrine exposure. * **Hormonal Contraceptives:** May decrease efficacy; advise use of barrier methods during and until the next cycle after treatment. ## Monitoring * Monitor baseline and follow-up cardiac status/ECG in patients at risk for QTc prolongation. * Monitor for signs of treatment failure (persisting fever or parasitemia). ## Clinical Pearls * **Administration:** MUST be taken with fatty food (e.g., milk, porridge, peanut butter) to significantly enhance absorption of lumefantrine, which is critical for preventing treatment failure. * **Adherence:** Ensure the full 6-dose regimen is completed even if the patient feels better. * **Pregnancy:** Use in the first trimester is generally avoided unless the benefit outweighs the risk, though current WHO guidelines support use in all trimesters for uncomplicated *P. falciparum*. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical practices vary by region and institutional protocols. Always verify current prescribing information, local resistance patterns, and patient-specific contraindications via official sources (e.g., WHO Malaria Guidelines or the manufacturer’s label) before prescribing or administering medication.