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# Arsil (Artemether/Lumefantrine)
## Overview
Arsil is a fixed-dose oral combination antimalarial agent. Artemether provides rapid symptomatic relief by reducing parasite biomass, while Lumefantrine provides a longer half-life to eliminate residual parasites.
## Primary Indications
Treatment of acute, uncomplicated *Plasmodium falciparum* malaria.
## Adult Dosing
Standard regimen for patients >35 kg: 4 tablets (each containing 20 mg artemether/120 mg lumefantrine) per dose.
* **Total treatment course:** 6 doses administered over 3 days (at 0, 8, 24, 36, 48, and 60 hours).
## Pediatric Dosing
Dosing is weight-based (using 20 mg/120 mg tablets):
* **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).
* **≥35 kg:** 4 tablets per dose (6 doses total).
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific guidelines; use with caution in severe cases due to lack of extensive data.
* **Vomiting:** If vomiting occurs within 1 hour of dosing, the dose should be repeated.
## Contraindications
* Known hypersensitivity to artemether or lumefantrine.
* Severe malaria (use parenteral artesunate).
* History of QTc prolongation or congenital long QT syndrome.
* Concomitant use of strong CYP3A4 inhibitors or inducers.
## Adverse Effects
* **Common:** Headache, dizziness, anorexia, fatigue, arthralgia, myalgia, and sleep disorders.
* **Serious:** QTc prolongation, hypersensitivity reactions, and potential for severe vomiting/diarrhea.
## Key Drug Interactions
* **QTc Prolonging Agents:** Increased risk of ventricular arrhythmias (e.g., amiodarone, quinolones, antipsychotics).
* **CYP3A4 Substrates:** Caution with drugs metabolized by 3A4; monitor effects closely.
* **Anti-retrovirals:** Certain PIs and NNRTIs may decrease lumefantrine concentrations.
## Monitoring
* **Cardiac:** EKG monitoring may be required in patients at high risk for cardiac conduction disturbances.
* **Clinical:** Monitor for treatment failure (persistence of parasitemia/clinical symptoms).
* **Diet:** Must be taken with fat-containing food (e.g., milk, porridge) to ensure adequate absorption of lumefantrine.
## Clinical Pearls
* **Absorption:** Bioavailability is significantly increased when co-administered with fat. If the patient cannot tolerate food, give with milk or a caloric-dense substitute.
* **Treatment Failure:** If vomiting persists or treatment fails, switch to an alternative effective antimalarial immediately.
* **Regulatory:** Availability and specific formulations may vary by region; verify local treatment guidelines.
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**Educational Disclaimer:** This information is for educational purposes only. Always consult the latest version of the manufacturer's prescribing information, local clinical protocols, and pharmacy guidelines before prescribing or administering medication.
