Can artesunate be given with hydroxyurea (Hydrea)?

Artesunate and Hydroxyurea Can Be Administered Together

Artesunate can be safely administered with hydroxyurea as there are no documented contraindications or significant drug interactions between these medications. While both medications are used for different conditions, there is no evidence in current guidelines suggesting they cannot be used concurrently.

Medication Overview and Indications

Artesunate

• First-line treatment for severe malaria, particularly severe falciparum malaria 1
• Administered intravenously at 2.4 mg/kg as a bolus at 0,12, and 24 hours, then daily 1, 2
• Provides rapid parasite clearance and has been shown to reduce mortality compared to quinine (15% vs 22%, absolute reduction of 34.7%) 2
• FDA approved in 2020 for treatment of severe malaria 3

Hydroxyurea

• Used in several conditions:
  • Sickle cell disease: Increases fetal hemoglobin and decreases vaso-occlusive complications 1
  • Myeloproliferative disorders: First-line cytoreductive therapy in polycythemia vera and essential thrombocythemia 1
  • Psoriasis: Off-label use with dosing of 500 mg PO twice daily, increasing up to 3 g/day as tolerated 1

Safety Considerations

Monitoring Requirements

When using these medications together:

1. Complete Blood Count (CBC) monitoring:

   • Hydroxyurea requires CBC monitoring at baseline and regularly during treatment due to potential myelosuppression 1
   • For patients on stable hydroxyurea doses, CBC should be monitored every 1-3 months 1
   • More frequent monitoring may be needed when initiating artesunate treatment

2. Parasite clearance monitoring:

   • For patients with malaria, monitor parasitemia every 12 hours after starting artesunate until decline to <1%, then every 24 hours until negative 1

3. Renal and hepatic function:

   • Both medications may affect renal and hepatic function, so regular monitoring is advisable

Potential Concerns and Management

While no direct contraindication exists, clinicians should be aware of:

1. Potential additive myelosuppression:

   • Hydroxyurea can cause bone marrow suppression 1
   • Monitor CBC more frequently when initiating artesunate in patients on hydroxyurea

2. Timing of administration:

   • Artesunate is typically given for a short duration (3 doses followed by oral therapy when possible) 1
   • Hydroxyurea is a chronic medication that should be continued during malaria treatment

3. Special populations:

   • In patients with sickle cell disease requiring malaria treatment, artesunate can be administered while continuing hydroxyurea therapy 1
   • For patients with myeloproliferative disorders, artesunate can be given with hydroxyurea when malaria treatment is indicated 1

Clinical Approach

1. For patients on chronic hydroxyurea requiring malaria treatment:

   • Initiate artesunate at standard dosing (2.4 mg/kg at 0,12, and 24 hours)
   • Continue hydroxyurea at the established dose
   • Monitor CBC more frequently during artesunate treatment

2. For patients with severe malaria who also require hydroxyurea:

   • Prioritize malaria treatment with artesunate
   • Initiate or resume hydroxyurea once the acute malaria episode is controlled
   • Ensure appropriate monitoring of both conditions

Conclusion

The available evidence does not indicate any contraindication to the concurrent use of artesunate and hydroxyurea. The benefits of treating severe malaria with artesunate (reduced mortality) and continuing disease-modifying therapy with hydroxyurea outweigh potential risks of co-administration. Appropriate monitoring of blood counts and clinical status should be implemented when using these medications together.