Artemether-Lumefantrine (ACT) Dosing for Uncomplicated Malaria
For adults and children over 35 kg with uncomplicated malaria, give artemether-lumefantrine (80mg/480mg) as 4 tablets at hour 0,4 tablets at hour 8, then 4 tablets twice daily on days 2 and 3 (total 24 tablets over 72 hours), and this must be taken with fatty food or drink to ensure adequate absorption. 1, 2
Adult Dosing (>35 kg)
- Day 1: Take 4 tablets at hour 0, then 4 tablets at hour 8 1, 3
- Day 2: Take 4 tablets in the morning (hour 24), then 4 tablets in the evening (hour 36) 1, 2
- Day 3: Take 4 tablets in the morning (hour 48), then 4 tablets in the evening (hour 60) 1, 3
- Total dose: 24 tablets over 72 hours 1
Pediatric Dosing by Weight
The dosing for children is weight-based using the 20mg/120mg pediatric formulation: 1
- 5-15 kg: 1 tablet per dose (following the same timing schedule as adults) 1
- 15-25 kg: 2 tablets per dose 1
- 25-35 kg: 3 tablets per dose 1
- >35 kg: Use adult dosing (4 tablets per dose) 1
Critical Administration Requirements
- Must be taken with fatty food or drink - this is not optional, as failure to ensure adequate fat intake results in subtherapeutic drug levels and treatment failure 2, 3, 4
- Examples of appropriate fatty meals include milk, butter, or other high-fat foods 2
- The complicated dosing regimen requires careful patient education to ensure compliance 1
Important Safety Considerations
- QTc prolongation: Avoid in patients at risk of QTc prolongation or taking medications that prolong QTc interval 1, 2, 3
- Common side effects: Headache, vertigo, and digestive disorders 1
- Pregnancy: Can be used in all trimesters of pregnancy as indicated by WHO and CDC 1, 4
- Efficacy: Cure rates of 96-100% when taken correctly 2, 4
Why This Matters
- Artemether-lumefantrine is the most widely adopted ACT regimen and the first fixed-dose artemisinin combination therapy manufactured under Good Manufacturing Practice conditions 5
- The rapid parasite clearance (median 39-43 hours) and reduction in hospital stay make it the most appropriate drug for uncomplicated P. falciparum malaria 1
- Treatment efficacy remains high even in pregnant women at standard non-pregnant dosing 4