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artemether and lumefantrine (Oral route)

ar-TEM-e-ther, loo-me-FAN-treen

Commonly used brand name(s)

In the U.S.

  • Coartem

Available Dosage Forms:

  • Tablet

Therapeutic Class: Antimalarial

Uses For artemether and lumefantrine

Artemether and lumefantrine combination is used to treat acute, uncomplicated malaria in patients who weigh at least 5 kilograms (11 pounds). It may be used to treat malaria infections in areas or regions where it is known that other medicines (e.g., chloroquine) may not work.

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Artemether and lumefantrine combination belongs to a group of medicines known as antimalarials. It treats malaria, a red blood cell infection transmitted by the bite of a mosquito. However, artemether and lumefantrine is not used to prevent malaria or to treat severe or complicated malaria.

artemether and lumefantrine is available only with your doctor's prescription.

Before Using artemether and lumefantrine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For artemether and lumefantrine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to artemether and lumefantrine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of artemether and lumefantrine combination in children. However, safety and efficacy have not been established in children weighing less than 5 kilograms (11 pounds).

Geriatric

Appropriate studies on the relationship of age to the effects of artemether and lumefantrine combination have not been performed in the geriatric population. However, geriatric-specific problems that would limit the usefulness of this medication in the elderly are not expected.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking artemether and lumefantrine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using artemether and lumefantrine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Amifampridine
  • Aurothioglucose
  • Carbamazepine
  • Cisapride
  • Dexamethasone
  • Dronedarone
  • Enzalutamide
  • Fluconazole
  • Fosphenytoin
  • Ketoconazole
  • Mesoridazine
  • Nelfinavir
  • Phenobarbital
  • Phenytoin
  • Pimozide
  • Piperaquine
  • Posaconazole
  • Primidone
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Saquinavir
  • Sparfloxacin
  • St John's Wort
  • Terfenadine
  • Thioridazine
  • Ziprasidone

Using artemether and lumefantrine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alfuzosin
  • Amiodarone
  • Amitriptyline
  • Amoxapine
  • Amprenavir
  • Apomorphine
  • Arsenic Trioxide
  • Asenapine
  • Astemizole
  • Atazanavir
  • Azithromycin
  • Bedaquiline
  • Boceprevir
  • Ceritinib
  • Chloroquine
  • Chlorpromazine
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clomipramine
  • Clozapine
  • Cobicistat
  • Conivaptan
  • Crizotinib
  • Cyclobenzaprine
  • Dabrafenib
  • Dasatinib
  • Delamanid
  • Delavirdine
  • Desipramine
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Domperidone
  • Droperidol
  • Efavirenz
  • Erythromycin
  • Escitalopram
  • Eslicarbazepine Acetate
  • Etravirine
  • Fingolimod
  • Flecainide
  • Fluoxetine
  • Formoterol
  • Fosamprenavir
  • Gatifloxacin
  • Gemifloxacin
  • Granisetron
  • Halofantrine
  • Haloperidol
  • Ibutilide
  • Iloperidone
  • Imipramine
  • Indinavir
  • Ivabradine
  • Lapatinib
  • Levofloxacin
  • Lopinavir
  • Methadone
  • Mifepristone
  • Mitotane
  • Moxifloxacin
  • Nelfinavir
  • Nevirapine
  • Nilotinib
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Ondansetron
  • Paliperidone
  • Pasireotide
  • Pazopanib
  • Pentamidine
  • Perflutren Lipid Microsphere
  • Perphenazine
  • Piperaquine
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranolazine
  • Ritonavir
  • Salmeterol
  • Saquinavir
  • Sevoflurane
  • Siltuximab
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Sunitinib
  • Tacrolimus
  • Telaprevir
  • Telavancin
  • Telithromycin
  • Tetrabenazine
  • Tipranavir
  • Tizanidine
  • Toremifene
  • Trazodone
  • Trifluoperazine
  • Trimipramine
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Vilanterol
  • Vinflunine
  • Voriconazole

Using artemether and lumefantrine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Darunavir
  • Mefloquine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using artemether and lumefantrine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use artemether and lumefantrine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Grapefruit Juice

Other Medical Problems

The presence of other medical problems may affect the use of artemether and lumefantrine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Bradycardia (slow heartbeat), severe or
  • Heart attack, recent or
  • Heart disease, severe or
  • Heart rhythm problems (e.g., prolonged QT interval, congenital long QT interval), or a history of or
  • Hypokalemia (low potassium in the blood) or
  • Hypomagnesemia (low magnesium in the blood)—Use is not recommended. May increase the risk of severe heart rhythm problems.
  • Decreased food intake during treatment—May increase the chance for this infection to return.
  • Kidney disease, severe or
  • Liver disease, severe—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of artemether and lumefantrine

Take artemether and lumefantrine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

artemether and lumefantrine comes with a patient information insert. Read and follow the instructions in the insert carefully. Talk with your doctor if you have any questions.

artemether and lumefantrine should be taken with food or drinks (e.g., milk, infant formula, pudding, porridge, or broth). This will help your body absorb the medicine.

If you or your child are unable to swallow the tablet, it may be crushed and mixed with one or two teaspoons of water in a clean container.

Keep using artemether and lumefantrine for the full treatment time, even if you feel better after the first few doses. Your infection may not clear up if you stop using the medicine too soon.

Dosing

The dose of artemether and lumefantrine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of artemether and lumefantrine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For the treatment of malaria:
      • Adults and children older than 16 years of age weighing 35 kilograms (kg) (77 pounds [lbs]) of body weight or more—At first, 4 tablets as a single dose, then one dose (4 tablets) after 8 hours. On days 2 and 3, take one dose (4 tablets) two times a day. This 3-day treatment schedule should have a total of 24 tablets in six doses.
      • Children weighing 25 kg (55 lbs) to less than 35 kg (77 lbs) of body weight—At first, 3 tablets as a single dose, then one dose (3 tablets) after 8 hours. On days 2 and 3, take one dose (3 tablets) two times a day. This 3-day treatment schedule should have a total of 18 tablets in six doses.
      • Children weighing 15 kg (33 lbs) to less than 25 kg (55 lbs) of body weight—At first, 2 tablets as a single dose, then one dose (2 tablets) after 8 hours. On days 2 and 3, take one dose (2 tablets) two times a day. This 3-day treatment schedule should have a total of 12 tablets in six doses.
      • Children weighing 5 kg (11 lbs) to less than 15 kg (33 lbs) of body weight—At first, 1 tablet as a single dose, then one dose (1 tablet) after 8 hours. On days 2 and 3, take one dose (1 tablet) two times a day. This 3-day treatment schedule should have a total of 6 tablets in six doses.
      • Children weighing less than 5 kg of body weight—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of artemether and lumefantrine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you or your child vomit within 1 to 2 hours of taking artemether and lumefantrine, take another dose. If you vomit the second dose, tell your doctor right away. You may need to use a different medicine to treat your condition.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using artemether and lumefantrine

It is important that your doctor check your progress after treatment. This is to make sure that the infection is cleared up completely, and to allow your doctor to check for any unwanted effects.

If your symptoms do not improve within a few days or if they become worse, check with your doctor.

Tell your doctor if you have used other medicines to treat your malaria infection. Using artemether and lumefantrine together with halofantrine (Halfan®), mefloquine (Lariam®), or quinine may increase the chance for more serious side effects.

artemether and lumefantrine can cause changes in heart rhythms, such as a condition called QT prolongation. It may change the way your heart beats and cause fainting or serious side effects in some patients. Call your doctor right away if you have any symptoms of heart rhythm problems, such as fast, pounding, or irregular heartbeats.

Check with your doctor right away if you have flu-like symptoms (such as chills, fever, headache, or muscle pains) again after treatment with artemether and lumefantrine.

artemether and lumefantrine may cause serious allergic reactions. Call your doctor right away if you have a rash, itching, hives, hoarseness, trouble with breathing, trouble with swallowing, or any swelling of your hands, face, or mouth while you are using artemether and lumefantrine.

Malaria is spread by the bites of certain kinds of infected female mosquitoes. If you are living in or will be traveling to an area where there is a chance of getting malaria, the following mosquito-control measures will help to prevent infection:

  • If possible, avoid going out between dusk and dawn because it is at these times that mosquitoes most commonly bite.
  • Wear long-sleeved shirts and long trousers to protect your arms and legs, especially from dusk through dawn when mosquitoes are out.
  • Apply insect repellant, preferably one containing DEET, to uncovered areas of the skin from dusk through dawn when mosquitoes are out.
  • If possible, sleep in a screened or air-conditioned room or under mosquito netting sprayed with insecticide to avoid being bitten by malaria-carrying mosquitoes.
  • Use mosquito coils or sprays to kill mosquitoes in living and sleeping quarters during evening and nighttime hours.

artemether and lumefantrine may decrease the effects of birth control pills or transdermal patches. To avoid an unwanted pregnancy, it is a good idea to use additional contraceptive measures with your pills or patches (e.g., condoms, a diaphragm, or a contraceptive foam or jelly) while using artemether and lumefantrine.

Grapefruits and grapefruit juice may increase the effects of artemether and lumefantrine combination by increasing the amount of artemether and lumefantrine in your body. You should not eat grapefruit or drink grapefruit juice while you taking artemether and lumefantrine.

Do not take other medicines, including prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements, unless they have been discussed with your doctor. Artemether and lumefantrine combination should not be taken with certain other medicines, including carbamazepine (Tegretol®), phenytoin (Dilantin®), rifampin (Rifadin®, Rimactane®), or St. John's wort.

artemether and lumefantrine Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Abdominal or stomach pain
  • chills
  • cough
  • fast, irregular, pounding, or racing heartbeat or pulse
  • fever
  • headache
  • muscle aches
  • pale skin
  • right upper abdominal or stomach pain and fullness
  • sore throat
  • stuffy or runny nose
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • unusual tiredness or weakness
Less common
  • Accumulation of pus
  • acid or sour stomach
  • belching
  • black, tarry stools
  • bladder pain
  • blood in the urine
  • bloody or cloudy urine
  • body aches or pain
  • change in hearing
  • chest pain
  • cloudy urine
  • convulsions
  • cough producing mucus
  • decreased urine
  • diarrhea
  • difficult, burning, or painful urination
  • difficulty with breathing
  • difficulty with swallowing
  • dizziness
  • dry mouth
  • ear congestion
  • ear drainage
  • earache or pain in the ear
  • frequent urge to urinate
  • general feeling of discomfort or illness
  • heartburn
  • increased thirst
  • indigestion
  • joint pain
  • loss of appetite
  • loss of voice
  • lower back or side pain
  • mood changes
  • muscle pain or cramps
  • nasal congestion
  • nausea or vomiting
  • noisy breathing
  • numbness or tingling in the hands, feet, or lips
  • red rash with watery, yellow-colored, or pus filled blisters
  • shivering
  • shortness of breath
  • sneezing
  • sores, ulcers, or white spots on the lips or in the mouth
  • stomach discomfort, upset, or pain
  • sweating
  • swollen glands
  • swollen, red, tender area of infection
  • thick yellow to honey-colored crusts
  • tightness in the chest
  • troubled with sleeping
Incidence not known
  • Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Difficulty with moving
  • lack or loss of strength
  • muscle aching or cramping
  • muscle pain or stiffness
  • sleeplessness
  • unable to sleep
  • weight loss
Less common
  • Back pain
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • burning, dry, or itching eyes
  • continuing ringing or buzzing or other unexplained noise in the ears
  • difficulty having a bowel movement (stool)
  • discharge or excessive tearing
  • dizziness or lightheadedness
  • feeling of constant movement of self or surroundings
  • hearing loss
  • hives or welts
  • redness of the skin
  • redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
  • sensation of spinning
  • shakiness and unsteady walk
  • shakiness in the legs, arms, hands, or feet
  • trembling or shaking of the hands or feet
  • uncontrolled eye movements
  • unsteadiness, trembling, or other problems with muscle control or coordination

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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