Artemether-Lumefantrine is a fixed-dose combination antimalarial medication, classified as an Artemisinin-based Combination Therapy (ACT). It is the first-line treatment for uncomplicated Plasmodium falciparum malaria in India and globally, as per WHO and National Center for Vector Borne Diseases Control (NCVBDC) guidelines. Artemether provides rapid parasiticidal action, reducing parasite biomass by up to 10,000-fold per asexual cycle, while lumefantrine, a longer-acting partner drug, eliminates residual parasites and prevents recrudescence.
Adult: Standard 6-dose regimen over 3 days for patients ≥35 kg: Initial dose: 4 tablets (Artemether 60mg + Lumefantrine 360mg per tablet). Then, 4 tablets at 8, 24, 36, 48, and 60 hours after the first dose. Total: 24 tablets.
Note: MUST be taken with food (e.g., milk, biscuit, chapati with ghee/oil) or a milk-based nutritional supplement to ensure adequate absorption, especially of lumefantrine. If vomiting occurs within 1 hour of dosing, a repeat dose should be taken. Tablets can be crushed for children. Complete the full 3-day course even if symptoms improve.
The combination exerts a rapid, multi-stage schizonticidal effect. Artemether acts quickly on the early trophozoite stage, while lumefantrine acts on the later stages. The combination targets the parasite's digestive vacuole and other organelles.
Pregnancy: Category C (US FDA). Avoid in first trimester unless no alternative and benefit outweighs risk. Data from second/third trimester suggest it can be used if other ACTs are not available or suitable, but consult specialist. NCVBDC guidelines permit use in second and third trimesters.
Driving: May cause dizziness and fatigue. Patients should be cautioned about driving or operating machinery until their individual response is known.
| Rifampicin | Markedly reduces plasma concentrations of both artemether and lumefantrine, leading to treatment failure. | Contraindicated |
| Ketoconazole, Itraconazole | May increase plasma concentrations of lumefantrine, potentially increasing risk of QT prolongation. | Major |
| Antiretroviral Protease Inhibitors (e.g., Lopinavir/ritonavir) | May increase lumefantrine levels; monitor for QT prolongation. | Major |
| Antiepileptics (Carbamazepine, Phenytoin, Phenobarbital) | Reduce plasma concentrations of artemether/lumefantrine, risk of treatment failure. | Contraindicated |
| Antiarrhythmics (Amiodarone, Flecainide), Antipsychotics, Antidepressants | Additive risk of QT interval prolongation. | Major |
| Grapefruit Juice | May inhibit CYP3A4, potentially increasing drug levels. | Moderate |
Same composition (Artemether (60mg) + Lumefantrine (360mg)), different brands: