A fixed-dose combination (FDC) antimalarial therapy for the treatment of uncomplicated Plasmodium falciparum malaria. Artesunate is a rapid-acting artemisinin derivative that provides rapid parasite clearance, while Sulphadoxine and Pyrimethamine (SP) is a long-acting sulfonamide-dihydrofolate reductase inhibitor combination that provides sustained schizonticidal action and prevents recrudescence. This combination is a key component of Artemisinin-based Combination Therapy (ACT) as per the National Drug Policy on Malaria (2022) by the Government of India.
Adult: A single daily dose of Artesunate 200mg + Sulphadoxine 500mg + Pyrimethamine 25mg (1 tablet) for 3 consecutive days. Total dose: Artesunate 600mg, Sulphadoxine 1500mg, Pyrimethamine 75mg.
Note: Take with food or milk to minimize GI upset. Swallow the tablet whole with a full glass of water. Do not crush or chew. For pediatric dispersible tablets, disperse in a small amount of water immediately before administration. Ensure complete 3-day course even if symptoms improve earlier.
Combination therapy with synergistic and sequential action. Artesunate acts rapidly on the erythrocytic stage of the malaria parasite, causing parasite death within hours. Sulphadoxine and Pyrimethamine (SP) act on the folate synthesis pathway of the parasite, providing a slower but sustained schizonticidal effect, thereby eliminating residual parasites and preventing recrudescence.
Pregnancy: Category D (by Indian classification). Artesunate is embryotoxic in animals. Avoid in first trimester unless it is a life-threatening P. falciparum infection where benefits outweigh risks. In second and third trimesters, it can be used but with caution. SP carries risk of kernicterus in newborn if used near term. Consult specialist.
Driving: May cause dizziness and blurred vision. Patients should not drive or operate machinery until their response is known.
| Warfarin/Acenocoumarol | Sulphadoxine may displace warfarin from protein binding, increasing INR and bleeding risk. Pyrimethamine may potentiate antifolate effect. | Major |
| Phenytoin | Sulphadoxine may inhibit metabolism, increasing phenytoin toxicity (nystagmus, ataxia). | Major |
| Sulfonylureas (e.g., Glimepiride) | Sulphadoxine may potentiate hypoglycemic effect. | Moderate |
| Methotrexate | Pyrimethamine increases antifolate effect, risk of severe bone marrow suppression. | Contraindicated |
| Other antifolates (Trimethoprim, Proguanil) | Increased risk of megaloblastic anemia. | Contraindicated |
| Rifampicin | Induces metabolism of pyrimethamine, reducing its efficacy. | Moderate |
| Cyclosporine | Sulphadoxine may reduce cyclosporine levels, risk of transplant rejection. | Moderate |
Same composition (Artesunate (200mg) + Sulphadoxine (500mg) + Pyrimethamine (25mg)), different brands: