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# Arsil (Artemether/Lumefantrine) ## Overview Arsil is a fixed-dose combination antimalarial (artemisinin derivative and arylamino alcohol). It is the World Health Organization (WHO) gold standard for uncomplicated *Plasmodium falciparum* malaria. ## Primary Indications Treatment of acute, uncomplicated malaria caused by *Plasmodium falciparum* and mixed infections including *P. falciparum*. ## Adult Dosing A 6-dose regimen is required over 3 days: * **Weight >35 kg:** 80 mg artemether / 480 mg lumefantrine (4 tablets) per dose. * **Schedule:** Initial dose, followed by a second dose after 8 hours, then twice daily (morning/evening) for the next 2 days. * **Total:** 6 doses. ## Pediatric Dosing Weight-based dosing is critical to ensure efficacy and safety: * **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. * **Weight ≥35 kg:** Use adult dosing. * **Schedule:** Same 6-dose regimen (0, 8, 24, 36, 48, and 60 hours). ## Dose Adjustments * **Renal/Hepatic Impairment:** No formal adjustments established, but use with caution. Monitor for increased levels due to potential reduced hepatic metabolism. * **Pregnancy:** Safe for use in the second and third trimesters. Use in the first trimester is generally recommended if other treatments are unavailable or ineffective. ## Contraindications * Hypersensitivity to artemether or lumefantrine. * Severe malaria (use injectable artesunate). * History of QT prolongation or cardiac arrhythmias. * Concomitant use of QTc-prolonging drugs. * Family history of sudden death or congenital long QT syndrome. ## Adverse Effects * **Common:** Headache, dizziness, anorexia, sleep disorders, arthralgia, myalgia. * **Serious:** QT interval prolongation (dose-dependent), hypersensitivity reactions, drug-induced hepatitis. ## Key Drug Interactions * **CYP3A4 Inhibitors/Inducers:** Strong inhibitors (e.g., ketoconazole) may increase levels; strong inducers (e.g., rifampin, carbamazepine) may decrease concentrations and increase treatment failure risk. * **QT Prolonging Agents:** Absolute avoidance of antiarrhythmics (Class IA/III), certain antipsychotics, and erythromycin. * **Hormonal Contraceptives:** May decrease efficacy; recommend back-up barrier contraception. ## Monitoring * **QTc prolongation:** If patient is high-risk, consider baseline and follow-up ECG. * **Clinical:** Resolution of fever and parasitemia. * **Efficacy:** If vomiting occurs within 1 hour of administration, the dose must be repeated. ## Clinical Pearls * **Absorption:** Must be taken with fat-containing food (e.g., milk, porridge) to significantly increase bioavailability; fasting reduces efficacy. * **Compliance:** Stress the importance of completing all 6 doses, even if the patient feels better, to prevent recrudescence and resistance. * **Administration:** Tablets may be crushed and mixed with water or milk for small children. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical protocols for malaria vary by region/country (e.g., CDC vs. WHO guidelines). Always verify current prescribing information, local resistance patterns, and institutional guidelines before prescribing or administering medication.