Eluxadoline
Severe
Database
Clinical effect not specified
Source: DDInter
Drug reference
Artesunate
Antimalarial (artemisinin derivative / endoperoxide) · Antibiotic
Also known as Artesunate sodium, Artesun, Falcigo
START
Uncomplicated: Start ACT (artesunate + partner drug) immediately if malaria confirmed or strongly suspected. Severe: Start IV artesunate within 1 hour of diagnosis
TYPICAL MAX
Follow WHO weight-based dosing tables; do not deviate
STOP IF
Complete full 3-day course even if patient feels better; incomplete courses drive resistance
WATCH
Hemoglobin at days 7, 14, 21, 28 (delayed hemolysis), parasite clearance, blood glucose (hypoglycemia in severe malaria)
CDSCO approvedSchedule HJan AushadhiNPPA price-controlledATC P01BE03
KDIGO 2024 + manufacturer label
- ONSET
- 6min · Rapid antimalarial onset (minutes for IV)
- PEAK
- 1h · Peak plasma concentration
- t½
- 1h · Very short half-life (needs partner drug)
- DURATION
- 4h · Short duration - requires combination therapy
EXCRETION
Biliary/fecal and renal
route + CYP
INTERACTIONS
4 major
SEVERE in our sources
PREGNANCY
First trimester: avoid unless no alternative; Second/third trimester: safe and recommended for malaria treatment
FDA category + note
Top interactionssee all 12 →
- EluxadolineSevereDatabaseDDInter
- GrazoprevirSevereDatabaseDDInter
- RifampicinSevereDatabaseDDInter
- RitonavirSevereDatabaseDDInter
Available in India
484 branded formulations and 8 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
The endoperoxide bridge is cleaved by intra-parasitic iron (heme), generating reactive oxygen species and carbon-centered free radicals that alkylate parasite proteins, disrupt membranes, and inhibit PfATP6 (SERCA-type calcium pump), leading to parasite death
Indications
Uncomplicated falciparum malaria (first-line, in ACT combinations)Severe falciparum malaria (IV artesunate - first-line per WHO)Malaria in pregnancy (second and third trimesters)Vivax malaria (when chloroquine resistance suspected)
Dosing
- Adult
- Uncomplicated malaria (oral, as ACT): 4 mg/kg/day x 3 days combined with partner drug. Severe malaria (IV): 2.4 mg/kg at 0, 12, 24 hours then daily until oral therapy possible
- Pediatric
- Same mg/kg dosing as adults; weight-based
- Renal adjustment
- No adjustment needed
- Hepatic adjustment
- No adjustment needed in acute malaria; caution in severe hepatic impairment
- Geriatric
- Standard weight-based dosing
- Max dose
- Follow weight-based dosing; do not exceed recommended mg/kg
Pharmacokinetics
Onset
Rapid (IV: minutes; oral: within 1 hour)
Peak effect
IV: immediate distribution; Oral: ~1 hour (Tmax)
Duration
Short (requires combination with longer-acting partner drug)
Half-life
~1 hour (parent compound); active metabolite DHA: 1-2 hours
Bioavailability
Oral: ~60-70%
Protein binding
~85%
Metabolism
Rapid hepatic hydrolysis to dihydroartemisinin (DHA, the primary active metabolite)
Excretion
Biliary/fecal and renal
Contraindications
- First trimester of pregnancy (relative - use only if no alternative)
- Hypersensitivity to artemisinin derivatives
- History of severe allergic reaction to artesunate
Side effects
Common
HeadacheDizzinessNauseaVomitingAnorexiaFever clearance-related symptoms
Serious
- Hemolytic anemia (delayed, 1-4 weeks post-treatment - blackwater fever)
- Neutropenia
- Elevated liver enzymes
- Severe allergic reactions (rare)
- QT prolongation (rare, usually with amodiaquine combination)
Pregnancy & lactation
Pregnancy
First trimester: avoid unless no alternative; Second/third trimester: safe and recommended for malaria treatment
Lactation
Excreted in breast milk in small amounts; compatible with breastfeeding; infant should receive own antimalarial treatment if indicated
Drug interactions
Grazoprevir
Severe
Database
Clinical effect not specified
Source: DDInter
Rifampicin
Severe
Database
Significantly reduced exposure to dihydroartemisinin (DHA), the active metabolite of artesunate, leading to a high risk of treatment failure.
Avoid co-administration. If rifampicin is essential, consider alternative antimalarial regimens that are not significantly metabolized by these CYP enzymes or are less susceptible to induction. If artesunate must be used, monitor closely for treatment failure and consider increasing artesunate dose, though specific recommendations are lacking.
Source: DDInter
Ritonavir
Severe
Database
Reduced exposure to dihydroartemisinin (DHA), the active metabolite of artesunate, potentially leading to treatment failure. Ritonavir is a potent inducer of CYP2A6, CYP2B6, and CYP2C19, which are involved in artesunate metabolism. However, ritonavir is also a strong CYP3A4 inhibitor, and the net ef
Avoid co-administration if possible. If unavoidable, monitor for signs of treatment failure and consider alternative antimalarial regimens. Dose adjustment of artesunate is not well-established.
Source: DDInter
Amodiaquine
Moderate
Database
Additive hepatotoxicity risk; amodiaquine can cause neutropenia and hepatotoxicity
Monitor LFTs and CBC; do not repeat amodiaquine within 1 month
Source: Kimi deep-research + Cla
Carbamazepine
Moderate
Database
Reduced exposure to dihydroartemisinin (DHA), the active metabolite of artesunate, potentially leading to treatment failure.
Monitor for signs of treatment failure. Consider alternative antimalarial regimens if possible. Dose adjustment of artesunate is not well-established.
Source: DDInter
Efavirenz
Moderate
Database
Reduced exposure to dihydroartemisinin (DHA), the active metabolite of artesunate, potentially leading to treatment failure.
Monitor for signs of treatment failure. Consider alternative antimalarial regimens if possible. Dose adjustment of artesunate is not well-established.
Enzyme Inducers
Moderate
Database
Reduced artesunate exposure via CYP induction; may reduce efficacy
Monitor parasite clearance; consider alternative antimalarial if treatment failure
Source: Kimi deep-research + Cla
Itraconazole
Moderate
Database
Increased exposure to artesunate and dihydroartemisinin (DHA). While this might seem beneficial, excessive levels could theoretically increase the risk of dose-dependent adverse effects, though clinical significance is not fully established for artesunate.
Monitor for increased adverse effects. Dose adjustment of artesunate is generally not required unless adverse effects are observed.
Ketoconazole
Moderate
Database
Increased exposure to artesunate and dihydroartemisinin (DHA). While this might seem beneficial, excessive levels could theoretically increase the risk of dose-dependent adverse effects, though clinical significance is not fully established for artesunate.
Monitor for increased adverse effects. Dose adjustment of artesunate is generally not required unless adverse effects are observed.
Mefloquine
Moderate
Database
Increased risk of neuropsychiatric adverse effects when mefloquine follows artesunate
Monitor for dizziness, confusion, sleep disturbances
Source: Kimi deep-research + Cla · p1740
Nevirapine
Moderate
Database
Reduced exposure to dihydroartemisinin (DHA), the active metabolite of artesunate, potentially leading to treatment failure.
Monitor for signs of treatment failure. Consider alternative antimalarial regimens if possible. Dose adjustment of artesunate is not well-established.
Source: DDInter
Related guidelines
Malaria treatment
ICMR · Infectious Disease · 2021
Antimicrobial resistance — clinical roadmap
MOHFW · Infectious Diseases · 2012
Iron deficiency anaemia in pregnancy
ICMR · Obstetrics & Gynaecology · 2022
Hypertensive disorders of pregnancy
FOGSI · Obstetrics & Gynaecology · 2019
Iron deficiency anaemia in pregnancy
FOGSI · Obstetrics & Gynaecology · 2017
Ask House about Artesunate
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Harrison 22e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19