Recommended Dosage of Artemether-Lumefantrine for Uncomplicated P. falciparum Malaria
The recommended dosage of artemether-lumefantrine (AL) for treating uncomplicated Plasmodium falciparum malaria is 20/120 mg (artemether/lumefantrine) tablets given as 4 tablets initially, followed by 4 tablets after 8 hours, then 4 tablets twice daily (morning and evening) for the following 2 days, for a total of 6 doses over 3 days. 1
Dosing Schedule Based on Weight
- For adults and children weighing 35 kg and above: 4 tablets per dose for a total of 6 doses over 3 days 2, 1
- For children weighing 25 to <35 kg: 3 tablets per dose for a total of 6 doses over 3 days 2, 1
- For children weighing 15 to <25 kg: 2 tablets per dose for a total of 6 doses over 3 days 2, 1
- For children weighing 5 to <15 kg: 1 tablet per dose for a total of 6 doses over 3 days 2, 1
Administration Guidelines
- AL should always be taken with food or milk to enhance absorption of lumefantrine 1, 3
- The six-dose regimen is significantly more effective than the previously used four-dose regimen, with cure rates of 96.9-99.12% compared to 83.3% for the four-dose regimen 4
- Tablets may be crushed and mixed with 1-2 teaspoons of water immediately prior to administration for patients who have difficulty swallowing, including children 1
Efficacy and Evidence
- Clinical trials have demonstrated high efficacy of AL when administered as a six-dose regimen, with cure rates of 99.3% in Uganda and 100% in other studies 2
- The six-dose regimen has been shown to be highly effective for treating multidrug-resistant falciparum malaria 4
- Once-daily dosing is not recommended as it results in 30% lower drug exposure and reduced efficacy compared to twice-daily dosing 3
Important Considerations and Precautions
- AL should not be used in patients with known QT prolongation, hypokalemia, hypomagnesemia, or those taking other QT-prolonging drugs 1
- AL should not be administered within one month of halofantrine due to potential additive effects on the QT interval 1
- Use caution when administering AL with CYP3A4 inhibitors or inducers, as they may affect drug levels and efficacy 1
- Strong CYP3A4 inducers such as rifampin, carbamazepine, phenytoin, and St. John's wort are contraindicated with AL 1
- Hormonal contraceptives may have reduced effectiveness when taken with AL; an additional method of birth control is recommended 1
Common Adverse Effects
- Most common adverse reactions in adults (>30%): headache, anorexia, dizziness, asthenia, arthralgia, and myalgia 1
- Most common adverse reactions in children (>12%): pyrexia, cough, vomiting, anorexia, and headache 1
Special Populations
- For pregnant women in the second and third trimesters, AL is effective at the same doses recommended for non-pregnant women 2
- The CDC recommends AL as an option for treatment of uncomplicated malaria in pregnant women during the second and third trimesters 2
- AL has shown high efficacy in geographical regions where resistance to chloroquine has been reported 1, 5
Remember that adherence to the complete six-dose regimen is crucial for treatment success and to prevent the development of resistance 6, 7.