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# Arsil (Artemether/Lumefantrine) ## Overview Arsil is a fixed-dose oral combination antimalarial. It functions by inhibiting nucleic acid and protein synthesis (Artemether) and interfering with hemozoin formation (Lumefantrine). ## Primary Indications Treatment of uncomplicated *Plasmodium falciparum* malaria. It is not indicated for malaria prophylaxis or severe malaria. ## Adult Dosing Standard regimen is a 6-dose course over 3 days (totaling 480mg Artemether / 2880mg Lumefantrine for a 60kg adult). * **Weight >35 kg:** 4 tablets (20mg/120mg each) per dose at 0, 8, 24, 36, 48, and 60 hours. * **Total:** 24 tablets. ## Pediatric Dosing Dosing is strictly weight-based. Ensure the child receives the full course to prevent recurrence. * **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). ## Dose Adjustments * **Renal/Hepatic Impairment:** No specific guidelines exist; caution is advised due to potential for increased exposure. * **Vomiting:** If the patient vomits within 30 minutes of administration, the dose must be repeated. ## Contraindications * Known hypersensitivity to Artemether or Lumefantrine. * Severe malaria (based on WHO criteria). * Family history of congenital long QT syndrome or sudden cardiac death. * Concomitant use of drugs that prolong the QT interval (e.g., flecainide, procainamide, high-dose macrolides). ## Adverse Effects * **Common:** Headache, dizziness, anorexia, nausea, vomiting, abdominal pain, arthralgia, and myalgia. * **Serious:** QT interval prolongation, hypersensitivity reactions, and potential for delayed hemolytic anemia. ## Key Drug Interactions * **CYP3A4 Inhibitors/Inducers:** Strong inhibitors (e.g., ketoconazole) may increase drug levels; strong inducers (e.g., rifampin, carbamazepine) may decrease efficacy. * **Hormonal Contraceptives:** May decrease efficacy of ethinyl estradiol; use barrier contraception during treatment. * **QT Prolonging Agents:** Strictly avoid concurrent use due to risk of Torsades de Pointes. ## Monitoring * **QTc Interval:** Baseline and serial ECGs in patients with history of cardiac arrhythmias or electrolyte disturbances. * **Clinical:** Monitor for failure to respond to treatment (persistent fever, parasitemia). * **Electrolytes:** Ensure potassium and magnesium levels are replete in patients with diarrhea or vomiting. ## Clinical Pearls * **Administration:** Must be taken with fat-containing food (milk, porridge, or peanuts) to significantly increase absorption. Lumefantrine absorption is poor on an empty stomach. * **Follow-up:** Check for therapeutic efficacy via repeat blood smear if symptoms persist. * **Regional Protocols:** Always verify against local Ministry of Health OR WHO guidelines for malaria, as drug resistance patterns vary significantly by geography. *** *Disclaimer: This information is for educational purposes only. Always consult current institutional protocols, the package insert, and official guidelines (such as the WHO Guidelines for Malaria) before prescribing or administering medication.*