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# Arsil (Artemether/Lumefantrine)
## Overview
Arsil is a fixed-dose oral combination antimalarial consisting of an artemisinin derivative (artemether) and an arylamino alcohol (lumefantrine). It is the first-line treatment for uncomplicated *Plasmodium falciparum* malaria.
## Primary Indications
Treatment of acute, uncomplicated *Plasmodium falciparum* malaria in patients weighing ≥5 kg.
## Adult Dosing
Standard regimen is six doses over 3 days (0, 8, 24, 36, 48, and 60 hours).
* **Patients ≥35 kg:** 4 tablets (each containing 20 mg artemether/120 mg lumefantrine) per dose.
* **Maximum:** 24 tablets total per course.
## Pediatric Dosing
Weight-based dosing (using 20 mg/120 mg tablets):
* **5 kg to <15 kg:** 1 tablet per dose.
* **15 kg to <25 kg:** 2 tablets per dose.
* **25 kg to <35 kg:** 3 tablets per dose.
* *Note:* Tablets may be crushed for younger children to ensure accurate dosing.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific guidelines; use with caution in severe impairment as safety data is limited.
* **Vomiting:** If patient vomits within 30 minutes of dose, repeat the full dose.
## Contraindications
* Known hypersensitivity to artemether or lumefantrine.
* Severe malaria (use parenteral artesunate).
* History of QT prolongation or congenital long QT syndrome.
* Concomitant use of strong CYP3A4 inhibitors/inducers or drugs known to prolong the QT interval (e.g., amiodarone, quinidine).
## Adverse Effects
* **Common:** Headache, dizziness, anorexia, sleep disturbance, abdominal pain, diarrhea, nausea/vomiting, palpitation, arthralgia, and myalgia.
* **Serious:** QTc prolongation, hypersensitivity reactions.
## Key Drug Interactions
* **CYP3A4 substrates/inhibitors:** Use caution with medications affecting CYP3A4 pathways.
* **QT-prolonging agents:** Absolute contraindication due to risk of Torsades de Pointes.
* **Hormonal Contraceptives:** May decrease efficacy; advise use of backup barrier methods for the duration of treatment.
## Monitoring
* Monitor for signs of treatment failure (e.g., recurring fever, parasite presence on blood smear).
* Baseline ECG recommended in patients at risk for cardiac rhythm disturbances if prolonged therapy is required or if combined with other at-risk drugs.
## Clinical Pearls
* **Oral Bioavailability:** Must be taken with fat-containing food (e.g., milk, porridge, or buttered bread) to significantly increase absorption.
* **Compliance:** The 6-dose regimen is critical for preventing recrudescence; ensure patient understands the strict 60-hour timing window.
* **Regional Protocols:** Always verify local resistance patterns and national treatment guidelines, which may supersede generalized dosage schedules.
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**Educational Disclaimer:** This information is for educational purposes only. Always consult the official package insert, institutional pharmacy protocols, or the most current CDC/WHO malaria treatment guidelines before prescribing or administering medication. Verifying local treatment resistance data is mandatory.
