From the Guidelines
Injection artesunate can cause several adverse effects, including haemoglobinuria and post-artesunate delayed haemolysis (PADH), which are the most serious adverse effects associated with its use. According to the most recent evidence 1, the adverse effects of injection artesunate include:
- Haemoglobinuria
- Post-artesunate delayed haemolysis (PADH) These adverse effects are significant and require monitoring, particularly in patients with high parasite loads. The evidence suggests that PADH is a serious adverse effect that can occur after treatment with artesunate, and it is essential to monitor patients for this condition, especially in the weeks following treatment 1. Additionally, other adverse effects such as nausea, vomiting, and dizziness may occur, but they are generally less severe and transient. It is crucial for healthcare providers to be aware of these potential adverse effects and to monitor patients receiving artesunate accordingly, particularly for delayed hemolysis in the weeks following treatment, especially in non-immune travelers returning from endemic areas.
From the Research
Adverse Effects of Injection Artesunate
The adverse effects of injection artesunate are primarily related to delayed-onset hemolytic anemia. Key points to consider include:
- Delayed-onset hemolytic anemia has been observed in approximately 20% of travelers who receive artesunate, with around 60% of these cases requiring transfusion 2.
- The pathophysiology of post-artesunate delayed hemolysis (PADH) is not fully understood, but it is thought to be related to the "pitting" of red blood cells carrying dead parasites killed by artesunate's action 3.
- Most patients with PADH present with clinical features of hemolytic anemia 7 days or later after the initiation of artesunate, and the benefits of artesunate treatment outweigh its adverse events 3.
- Delayed haemolysis is a frequent complication in hyperparasitemic malaria treated with intravenous artesunate, and follow-up is mandatory for at least 2 weeks after treatment initiation 4.
- Adverse events observed in patients treated with artesunate are limited to delayed haemolysis and temporary deterioration in renal function, whereas patients treated with quinine show a more diverse picture of side effects 5.
- Cases of delayed hemolytic anemia after treatment with injectable artesunate are manageable, and all cases of delayed anemia are clinically manageable and resolve within one month 6.
Common Adverse Effects
Some common adverse effects of injection artesunate include:
- Delayed-onset hemolytic anemia
- Temporary deterioration in renal function
- Decrease in hemoglobin levels
- Hemolytic anemia
- Delayed haemolysis
Management and Follow-up
It is essential to follow up with patients treated with artesunate for severe malaria to detect any delayed hemolytic events early and prevent potentially serious consequences 3, 4, 5, 6.