Piperaquine phosphate with artenimol

How it works

Artenimol provides rapid parasite killing through reactive intermediates generated by cleavage of its endoperoxide bridge, while piperaquine, a bisquinoline, provides a longer-acting blood schizonticidal effect that suppresses recrudescence.

Prescribing in practice

• It prolongs the QT interval, so it is contraindicated where there is congenital long QT, symptomatic arrhythmia or concurrent use of other QT-prolonging drugs, and a pre-treatment ECG may be warranted in at-risk patients.
• It should be taken on an empty stomach because food markedly increases piperaquine absorption and the associated cardiac risk.
• It is reserved for uncomplicated malaria; severe or complicated malaria requires parenteral artesunate per current guidance.

Monitoring

Assess for cardiac risk factors and consider ECG monitoring of the QT interval in susceptible patients, with confirmation of parasitological response.

Counselling the patient

• Take the tablets without food, separated from meals as advised.
• Complete the full course even if you feel better to ensure the infection is cleared.
• Report palpitations, fainting or known heart-rhythm problems before or during treatment.

Evidence & guidelines

Dihydroartemisinin-piperaquine is a WHO-recommended artemisinin-based combination therapy for uncomplicated falciparum malaria.