Qt Prolonging Drugs
Contraindicated
Database
Additive QT prolongation; risk of torsades de pointes
Avoid concurrent use
Source: Kimi deep-research + Cla
Drug reference
Artemether + Lumefantrine
Antimalarial combination (artemisinin derivative + arylaminoalcohol) · Antimalarial
Also known as Coartem, Lumerax, Artenam, Artemether-lumefantrine, Riamet
START
Confirm malaria diagnosis (RDT or microscopy); start weight-based dosing immediately; give with fatty food or milk
TYPICAL MAX
4 tablets per dose for >/=50 kg adults; complete all 6 doses over 3 days
STOP IF
Complete full 6-dose course; do not stop early even if feeling better
WATCH
Hemoglobin at days 7, 14, 21, 28 (delayed hemolysis), ECG if cardiac risk, parasite clearance at day 3, ensure fatty food with each dose
CDSCO approvedSchedule HATC P01BF01
KDIGO 2024 + manufacturer label
- ONSET
- 2h · Rapid fever and parasite clearance
- PEAK
- 2h · Artemether peak
- t½
- 4d · Lumefantrine half-life (3-6 days)
- DURATION
- 3w · Lumefantrine post-treatment prophylaxis (2-3 weeks)
EXCRETION
Fecal (both components)
route + CYP
INTERACTIONS
2 major
incl. contraindicated
PREGNANCY
First trimester: avoid unless no alternative; Second/third trimester: recommended for malaria treatment
FDA category + note
Top interactionssee all 5 →
- Qt Prolonging DrugsContraindicatedDatabaseKimi deep-research + Cla
- RifampicinContraindicatedDatabaseKimi deep-research + Cla
Available in India
0 branded formulations and 347 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Mechanism
Artemether: Endoperoxide bridge cleaved by heme iron generates free radicals that alkylate parasite proteins and inhibit PfATP6. Lumefantrine: Accumulates in parasite food vacuole, inhibiting hematin polymerization. Combined for rapid parasite clearance and prevention of recrudescence.
Indications
Uncomplicated Plasmodium falciparum malaria (first-line ACT per WHO)Mixed malaria infections
Dosing
- Adult
- Weight-based: 20-24 kg: 1 tab; 25-34 kg: 2 tabs; 35-49 kg: 3 tabs; >/=50 kg: 4 tabs. Dose at 0, 8, 24, 36, 48, 60 hours (6 doses over 3 days). Take with fatty food/milk.
- Pediatric
- Same weight-based dosing; tablets can be crushed for children unable to swallow
- Renal adjustment
- No adjustment needed
- Hepatic adjustment
- No adjustment in mild-moderate; avoid in severe hepatic impairment
- Geriatric
- Standard weight-based dosing
- Max dose
- 4 tablets per dose (>/=50 kg adult)
Pharmacokinetics
Onset
Rapid (fever clearance within 24-48 hours)
Peak effect
Artemether: 2 hours; Lumefantrine: 6-8 hours
Duration
Lumefantrine provides post-treatment prophylaxis for ~2-3 weeks
Half-life
Artemether: 1-2 hours; Lumefantrine: 3-6 days
Bioavailability
Artemether: variable; enhanced by food. Lumefantrine: highly lipophilic, absorption increased 2-4x with fatty meal
Protein binding
Artemether: ~95%; Lumefantrine: >99%
Metabolism
Artemether: Hepatic CYP3A4/5 to active metabolite DHA. Lumefantrine: Hepatic CYP3A4 to desbutyl-lumefantrine (active)
Excretion
Artemether: Biliary/fecal. Lumefantrine: Fecal (major)
Contraindications
- First trimester pregnancy (relative)
- Previous hypersensitivity to artemether, lumefantrine, or structurally related compounds
- Family history of congenital QT prolongation or sudden death
- Ventricular arrhythmias
- Severe hepatic impairment
- Concurrent use with CYP3A4 inducers (strong) or QT-prolonging drugs
Side effects
Common
HeadacheDizzinessAnorexiaNauseaVomitingAbdominal painArthralgiaMyalgiaSleep disorders
Serious
- QT interval prolongation
- Hepatotoxicity
- Severe skin reactions
- Delayed hemolytic anemia (1-4 weeks post-treatment)
- Prolonged QT leading to torsades de pointes (rare)
Pregnancy & lactation
Pregnancy
First trimester: avoid unless no alternative; Second/third trimester: recommended for malaria treatment
Lactation
Both components excreted in breast milk; infant should receive own antimalarial treatment if indicated; compatible per WHO
Drug interactions
Rifampicin
Contraindicated
Database
Significantly reduces artemether and lumefantrine exposure, risking treatment failure
Avoid concurrent use; choose alternative antimalarial
Source: Kimi deep-research + Cla
Antiretrovirals
Moderate
Database
CYP induction may reduce ACT efficacy; protease inhibitors may increase levels
Monitor parasite clearance; consider dose adjustment if available
Source: Kimi deep-research + Cla
Ketoconazole
Moderate
Database
Increases lumefantrine levels and QT prolongation risk
Use with caution; monitor ECG
Source: Kimi deep-research + Cla
Grapefruit Juice
Mild
Database
CYP3A4 inhibition increases lumefantrine absorption
Avoid grapefruit juice during treatment
Source: Kimi deep-research + Cla
Related guidelines
Ask House about Artemether + Lumefantrine
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