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# Arsil (Artemether/Lumefantrine) ## Overview Artemether/lumefantrine is a fixed-dose artemisinin-based combination therapy (ACT). Artemether provides rapid reduction in parasite biomass, while lumefantrine provides a longer half-life to clear residual parasites. ## Primary Indications Treatment of acute, uncomplicated *Plasmodium falciparum* malaria. ## Adult Dosing Standard regimen is a 3-day course (6 doses total). * **Weight >35 kg:** 4 tablets (20 mg artemether/120 mg lumefantrine per tablet) per dose. * **Schedule:** Initial dose at 0 hours, second dose at 8 hours, then twice daily (morning/evening) for the following 2 days. ## Pediatric Dosing Dosing is strictly weight-based. * **5 kg to <15 kg:** 1 tablet per dose (6 doses total). * **15 kg to <25 kg:** 2 tablets per dose (6 doses total). * **25 kg to <35 kg:** 3 tablets per dose (6 doses total). * **Schedule:** Initial dose, second dose at 8 hours, then twice daily for days 2 and 3. ## Dose Adjustments * **Renal/Hepatic Impairment:** No specific guidelines; use with caution in severe impairment. * **Emesis:** If the patient vomits within 30 minutes of administration, the dose should be repeated. ## Contraindications * Known hypersensitivity to artemether or lumefantrine. * Severe malaria (use intravenous artesunate). * History of QT prolongation or family history of sudden cardiac death. * Concomitant use of strong CYP3A4 inhibitors or inducers. ## Adverse Effects * **Common:** Headache, dizziness, anorexia, insomnia, arthralgia, myalgia, and fatigue. * **Serious:** QT interval prolongation (dose-dependent), hypersensitivity reactions, and rare cases of late-onset hemolytic anemia. ## Key Drug Interactions * **QT Prolonging Agents:** Avoid concomitant use with drugs like quinolones, antipsychotics, or antifungals (e.g., ketoconazole). * **CYP3A4 Substrates/Inducers:** Strong inducers (e.g., rifampin, phenytoin) may decrease efficacy; strong inhibitors (e.g., ritonavir, clarithromycin) may increase serum concentrations. * **Hormonal Contraceptives:** May reduce the efficacy of oral contraceptives; recommend alternative barrier methods during treatment. ## Monitoring * **Cardiac:** Monitor ECG in patients with history of cardiac arrhythmias or electrolyte imbalances (hypokalemia/hypomagnesemia). * **Efficacy:** Monitor for signs of treatment failure (persisting fever, parasitemia). * **Diet:** Must be administered with food or a high-fat drink (e.g., milk) to ensure adequate absorption of lumefantrine. ## Clinical Pearls * **Absorption:** Bioavailability is significantly reduced in fasting states. Ensure patients consume food with doses (especially the later doses). * **Compliance:** Complete the full 6-dose regimen even if symptoms resolve to prevent resistance. * **Pregnancy:** Artemether/lumefantrine is generally considered safe and effective in the second and third trimesters. Benefit/risk assessment is required in the first trimester. *** **Educational Disclaimer:** This information is for educational purposes only. Always consult the most current local prescribing information, institutional protocols, and official malaria treatment guidelines (e.g., WHO or CDC) before prescribing or administering medication.