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Artemisinin Derivative Antimalarial

Artesunate

Brand names: Artesun (IV), Falcimon (oral — not licensed UK)

Adult dose

Dose: Severe malaria (IV): 2.4 mg/kg IV at 0, 12, and 24 hours; then once daily until oral therapy tolerated (minimum 3 doses IV). Rectal artesunate (pre-referral in children): 10 mg/kg as single dose
Route: Intravenous (severe malaria); rectal (pre-referral)
Frequency: See dose schedule

Clinical pearls

  • Treatment of choice for severe malaria (cerebral malaria, hyperparasitaemia, multiorgan involvement) — superior to IV quinine (AQUAMAT trial)
  • UKHSA/PHE: IV artesunate is first-line for severe P. falciparum malaria in the UK
  • PADH: haemolysis 2–4 weeks post-treatment in up to 25% of severe malaria patients; monitor FBC for 4 weeks after IV artesunate
  • Follow IV artesunate with oral artemisinin-based combination therapy (ACT) once patient can tolerate oral treatment
  • Available as emergency supply from designated UK centres (imported licensed medicine — Artesun)
  • Rectal artesunate for pre-referral single-dose in children with suspected severe malaria in resource-limited settings (WHO recommendation)

Contraindications

  • Hypersensitivity to artesunate or other artemisinin derivatives

Side effects

  • Post-artesunate delayed haemolysis (PADH) — occurs 2–4 weeks after treatment; especially after high parasitaemias
  • Transient fall in haemoglobin (common)
  • Neutropenia
  • Elevated liver enzymes

Interactions

  • QT-prolonging drugs — theoretically additive; less QT effect than lumefantrine
  • Antiretrovirals — check interactions with protease inhibitors and efavirenz

Monitoring

  • Parasitaemia (blood films every 12 hours initially)
  • FBC (haemoglobin) during and for 4 weeks after treatment
  • Renal and hepatic function
  • Neurological status (cerebral malaria)
  • Glucose (hypoglycaemia in severe malaria)

Reference: BNF; PHE/UKHSA Malaria Treatment Guidelines (2022); AQUAMAT trial (Lancet 2010); WHO Guidelines for Treatment of Malaria (3rd ed.); https://bnf.nice.org.uk/drugs/artesunate/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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