Artemether-Lumefantrine

Artemether-lumefantrine is the most widely used artemisinin-based combination therapy (ACT) for the treatment of uncomplicated Plasmodium falciparum malaria — the most dangerous and prevalent type of malaria in Nigeria. It is the first-line treatment recommended by the Nigeria National Malaria Treatment Guidelines and the World Health Organization. The drug contains two active ingredients that work together through different mechanisms to kill malaria parasites, making it highly effective and reducing the risk of drug resistance developing. It is commercially available in Nigeria under brand names including Coartem and Lonart.

• First-line treatment of uncomplicated P. falciparum malaria in adults and children weighing 5 kg or more • Treatment of malaria when the causative species is unknown but P. falciparum is suspected • Not used for prevention of malaria: only for treatment of confirmed or strongly suspected malaria • Not recommended for severe or complicated malaria (which requires injectable artesunate)

Artemether-lumefantrine must be taken with food or a fatty meal or drink (e.g., milk, peanut butter, full-fat food) — this is essential because lumefantrine is poorly absorbed without dietary fat. In malnourished patients who cannot eat, ensure they take even a small amount of food. Standard adult regimen (6 doses over 3 days): • Weight-based dosing; for adults and children over 35 kg: 4 tablets per dose • Take 2 doses on Day 1 (an initial dose, then a second dose 8 hours later) • Take 1 dose in the morning and 1 dose in the evening on Days 2 and 3 • Always complete the full 3-day, 6-dose course even if feeling better: incomplete treatment promotes drug resistance Children: • Dose is determined by body weight: follow the dosing chart on the package or as directed by the healthcare provider Do not crush tablets and dissolve in water for infants — use a liquid formulation as directed.

Common side effects: • Headache • Dizziness • Nausea and vomiting • Abdominal pain • Loss of appetite • Muscle and joint pains • Sleep disturbances • Fatigue These side effects are often difficult to distinguish from the symptoms of malaria itself and usually improve as treatment progresses. Rare but important: • QT interval prolongation (heart rhythm abnormality): more relevant in patients with pre-existing heart conditions • Skin rash (stop and seek care if severe) • Severe allergic reaction (rare)

• Other antimalarials (halofantrine, quinine, mefloquine): increased risk of heart rhythm abnormalities; avoid combination if possible • Drugs that prolong the QT interval (certain antibiotics, antifungals, antidepressants, antipsychotics): risk of dangerous heart rhythm • Hormonal contraceptives: lumefantrine may reduce the effectiveness of oral contraceptives; use barrier methods during treatment and for the remainder of the cycle • Ketoconazole and other strong CYP3A4 inhibitors: increase lumefantrine levels • Rifampicin and other enzyme inducers: reduce drug levels and effectiveness; treat malaria with alternative ACT if patient is on rifampicin

• Store below 30°C in a cool, dry place away from sunlight • Keep out of reach of children • Protect from moisture — blister packs help; do not transfer tablets to other containers • Do not use after the expiry date on the packaging