Artemether/Lumefantrine Dosage

Usual Adult Dose for Malaria

Less than 35 kg: Usual pediatric dose

35 kg or more: 4 tablets as single initial dose, followed by 4 tablets after 8 hours, and then 4 tablets twice a day (morning and evening) for the following 2 days (total course: 24 tablets)

Usual Pediatric Dose for Malaria

5 kg to less than 15 kg: 1 tablet as single initial dose, followed by 1 tablet after 8 hours, and then 1 tablet twice a day (morning and evening) for the following 2 days (total course: 6 tablets)

15 kg to less than 25 kg: 2 tablets as single initial dose, followed by 2 tablets after 8 hours, and then 2 tablets twice a day (morning and evening) for the following 2 days (total course: 12 tablets)

25 kg to less than 35 kg: 3 tablets as single initial dose, followed by 3 tablets after 8 hours, and then 3 tablets twice a day (morning and evening) for the following 2 days (total course: 18 tablets)

35 kg or more: 4 tablets as single initial dose, followed by 4 tablets after 8 hours, and then 4 tablets twice a day (morning and evening) for the following 2 days (total course: 24 tablets)

Renal Dose Adjustments

No adjustment recommended. The manufacturer recommends caution when administering this drug to patients with severe renal dysfunction.

Liver Dose Adjustments

No adjustment recommended. The manufacturer recommends caution when administering this drug to patients with severe liver dysfunction.

Precautions

Decreased exposure to lumefantrine may occur if mefloquine is administered immediately prior to artemether-lumefantrine, possibly due to a mefloquine-induced decrease in bile production. Patients should be monitored for decreased efficacy and encouraged to consume food while taking artemether-lumefantrine.

Food increases artemether and lumefantrine absorption. Patients who remain averse to food during treatment should be closely monitored due to a higher risk of recrudescence. In the event of recrudescent Plasmodium falciparum infection following artemether-lumefantrine therapy, treatment with a different antimalarial is recommended.

Hypersensitivity reactions have been associated with artemether-lumefantrine. The drug should be discontinued at the first sign of skin rash, urticaria or other skin reactions, tachycardia, difficulty in swallowing or breathing, any swelling suggestive of angioedema, or other symptoms of an allergic reaction.

Limited data have shown artemether-lumefantrine to be effective against the erythrocytic stage of P vivax infection. However, relapsing malaria caused by P vivax requires additional treatment with other antimalarial drugs to achieve radical cure (i.e., eradicate hypnozoites that may be dormant in the liver).

Safety and effectiveness have not been established in pediatric patients who weigh less than 5 kg.

Dialysis

Data not available

Other Comments

Artemether-lumefantrine should be taken with food.

Artemether-lumefantrine tablets may be crushed and mixed with 1 to 2 teaspoons of water in a clean container for administration immediately prior to use. The patient can then rinse the container with more water and swallow the contents. This crushed tablet preparation should be followed by food/drink.

A repeat dose should be taken if the patient vomits within 1 to 2 hours of administration. If the repeat dose is vomited, an alternative antimalarial treatment is recommended.

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