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Artemisinin-Based Combination Antimalarial (ACT)

Artemether with Lumefantrine

Brand names: Riamet, Coartem

Adult dose

Dose: 4 tablets per dose (80 mg/480 mg total), given at 0, 8, 24, 36, 48, and 60 hours (6 doses total over 3 days; adult >35 kg)
Route: Oral
Frequency: 6 doses as above — MUST be taken with fat-containing food/drink

Clinical pearls

  • WHO-recommended and UKHSA/PHE first-line ACT for uncomplicated Plasmodium falciparum malaria (including imported cases)
  • MUST be taken with food containing fat (biscuits, milk, porridge) — significantly increases lumefantrine bioavailability
  • PHE/UKHSA Guidelines for Malaria Prevention in Travellers from UK (2022): artemether-lumefantrine is first choice for treatment of uncomplicated P. falciparum
  • For severe malaria: IV artesunate is preferred (not artemether-lumefantrine)
  • Complete all 6 doses even if feeling better to prevent recrudescence
  • Monitor ECG if QT prolongation history or concomitant QT drugs

Contraindications

  • QTc interval prolongation
  • Concomitant QT-prolonging drugs
  • Severe hepatic impairment
  • Hypersensitivity

Side effects

  • Headache
  • Dizziness
  • Nausea, vomiting
  • Arthralgia, myalgia
  • QT prolongation
  • Neutropenia (common — usually transient)

Interactions

  • QT-prolonging drugs — additive QT prolongation; avoid
  • CYP3A4 inducers (rifampicin, carbamazepine) — reduce lumefantrine levels; avoid
  • Antiretrovirals (especially efavirenz, lopinavir) — complex interactions; check BNF/ASHP
  • Antimalarial drugs containing mefloquine — avoid within 12 hours (seizure risk)

Monitoring

  • Parasitaemia (blood film at baseline, 72 hours, 28 days)
  • Temperature response (fever should resolve within 48–72 hours)
  • Full blood count (neutropenia, anaemia)
  • QTc if risk factors
  • Renal and hepatic function in severe illness

Reference: BNF; PHE/UKHSA Guidelines for Malaria Prevention and Treatment (2022); WHO Guidelines for Treatment of Malaria (3rd edition, 2015 updated); NICE CKS Malaria (2023); https://bnf.nice.org.uk/drugs/artemether-with-lumefantrine/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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