Piperaquine

Piperaquine is a bisquinoline antimalarial that accumulates in the parasite digestive food vacuole, where it inhibits heme polymerization to hemozoin — a mechanism shared with chloroquine. However, its bisquinoline structure retains activity against many chloroquine-resistant Plasmodium falciparum strains. Its extremely long elimination half-life (2-3 weeks) provides prolonged post-treatment prophylaxis, and it is used in fixed-dose combination with dihydroartemisinin as a WHO-recommended artemisinin combination therapy (ACT).

Adult

Adult (body-weight 40 kg and above): 320 mg (as Piperaquine phosphate, 1 tablet) once daily for 3 days

Pediatric

Child 6 months–17 years (body-weight 7–12 kg): 0.5 tablet once daily for 3 days, max. 2 courses in 12 months; second course given at least 2 months after first course. Child 6 months–17 years (body-weight 13–23 kg): 1 tablet once daily for 3 days, max. Child 6 months–17 years (body-weight 24–35 kg): 2 tablets once daily for 3 days, max.

Renal adjustment

Manufacturer advises caution in severe impairment. Monitor ECG and plasma potassium concentration.

Hepatic adjustment

Manufacturer advises caution in severe impairment (no information available)—monitor ECG and plasma potassium concentration.

• Family history of congenital QT interval prolongation
• Family history of sudden death
• History of arrhythmias
• History of clinically relevant bradycardia
• History of congestive heart failure accompanied by reduced left ventricular ejection fraction
• Acute porphyrias
• Electrolyte disturbances