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# Arsil (Artemether/Lumefantrine) ## Overview Artemether/lumefantrine is a fixed-dose combination fixed-dose antimalarial. Artemether provides rapid reduction in parasite biomass, while lumefantrine provides broader, sustained parasite clearance. It is commonly marketed as Coartem. ## Primary Indications Treatment of acute, uncomplicated *Plasmodium falciparum* malaria in patients weighing ≥5 kg. ## Adult Dosing Standard regimen is a 6-dose course over 3 days (at 0, 8, 24, 36, 48, and 60 hours). * **≥35 kg:** 4 tablets per dose (total 24 tablets). * **Maximum:** Do not exceed the 6-dose regimen. ## Pediatric Dosing Dosing is weight-based (6-dose course over 3 days): * **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. * **≥35 kg:** Use adult dosing (4 tablets per dose). ## Dose Adjustments * **Renal Impairment:** No formal dosage adjustments provided; use with caution. * **Hepatic Impairment:** No formal dosage adjustments provided; use with caution. ## Contraindications * Known hypersensitivity to artemether or lumefantrine. * Severe malaria (use parenteral antimalarials). * Concomitant use of strong CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin, St. John's wort). ## Adverse Effects * Common: Headache, dizziness, anorexia, fatigue, arthralgia, myalgia. * Serious: QT prolongation, hypersensitivity reactions/anaphylaxis, elevated liver enzymes. ## Key Drug Interactions * **CYP3A4 Inhibitors:** May increase lumefantrine plasma concentrations; monitor for toxicity. * **CYP3A4 Inducers:** May lead to treatment failure (contraindicated). * **QT-Prolonging Agents:** Avoid concomitant use with other drugs known to prolong the QT interval (e.g., halofantrine, quinidine, certain antiarrhythmics). ## Monitoring * **Cardiac:** Baseline ECG and potassium/magnesium levels in patients at risk for QT prolongation. * **Efficacy:** Monitor for resolution of symptoms and clearance of parasitemia. * **Safety:** Monitor for signs of hypersensitivity. ## Clinical Pearls * **Administration:** Must be taken with food or a high-fat drink (e.g., milk) to ensure adequate absorption of lumefantrine. * **Vomiting:** If the patient vomits within 1 hour of administration, the dose should be repeated. * **Pregnancy:** Use is recommended in all trimesters for uncomplicated falciparum malaria if other treatments are not options, though the first trimester remains a subject of clinical deliberation based on regional guidelines. * **Resistance:** Not recommended for malaria prophylaxis in non-endemic areas. *** **Educational Disclaimer:** This information is for educational purposes only. Always consult current institutional protocols and the full FDA-approved prescribing information (package insert) before prescribing or administering any medication. Clinical judgment should be used based on individual patient status.