The Pharmaceutical Journal
Vol 268 No 7195 p557-561
27 April 2002

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New combination malaria treatment

A new combination preparation for the treatment of uncomplicated Plasmodium falciparum malaria, Riamet, was launched this week by Novartis Pharmaceuticals (see p566). Riamet contains two antimalarials, artemether (previously available in the United Kingdom on a named-patient basis) and lumefantrine.

The company says that the product works by attacking the parasite's life cycle at two stages. It adds that artemether has a rapid onset of action, providing early reduction in parasites, whereas lumefantrine has a slower onset of action, preventing reappearance of parasites. In addition, Riamet is effective in areas of multi-drug resistance. A course of treatment, for patients aged 12 years and over and with a body weight of 35kg or more, consists of a regimen of six doses of four tablets (ie, 24 tablets in total) over 60 hours.

Riamet has not been evaluated for the treatment of complicated malaria, including cerebral malaria or other severe manifestations such as pulmonary oedema or renal failure. It is contraindicated in patients taking any drug that inhibits cytochrome CYP3A4 or any drug that is metabolised by CYP2D6, as well as in patients taking drugs that prolong the QTc interval on electrocardiograms. Concurrent administration with other antimalarials is also contraindicated.

Dr Larry Goodyer, superintendent of Nomad Travel Pharmacy, told The Journal that Riamet is a useful treatment option, especially in the light of recent cases of travellers with falciparum malaria failing to respond to current treatment options because of resistance to antimalarials.

However, he added that because of potential drug interactions and possible cardiac problems associated with Riamet, the product does not seem suitable as standby treatment for self-administration by travellers, away from medical help, in an emergency. "Pharmacists should be aware of potential interactions," he said.