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Alice M. Jenh, Pharm.D. and Paul A. Pham, Pharm.D.
08-11-2008
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Available formulation in Zambia: Tablet: 153 mg or 200 mg (as hydrochloride). Coarsucam™ (artesunate + amodiaquine fixed-dose combination) = 50 mg artesunate/153 mg amodiaquine per tablet
- Must be used in combination with artesunate 50 mg
- Treatment of falciparum malaria and uncomplicated chloroquine-resistant vivax malaria: 10 mg/kg daily for 3 days. (Note: Treatment of vivax malaria must be followed by radical cure with primaquine).
- Recommended dosing for Coarsucam™ (artesunate + amodiaquine fixed-dose combination): >40 kg should receive 4 tablets of each product per day.
- May be used alone for the treatment of P. vivax, P. ovale and P. malariae infections.
- With EFV co-administration, amodiaquine AUC increased by 114% and 302% in 2 subjects and resulted in significant LFTs elevations. Avoid co-administration or use with close monitoring.
Zambia Information Author: Alice M. Jenh
- Not available in the U.S.
- Treatment of falciparum malaria and uncomplicated chloroquine-resistant vivax malaria
- Dosages expressed in mg of amodiaquine base (amodiaquine hydrochloride 260 mg equivalent to 200 mg of amodiaquine base).
- Treatment of falciparum malaria and uncomplicated chloroquine-resistant vivax malaria: 10 mg/kg daily for 3 days. (Note: Treatment of vivax malaria must be followed by radical cure with primaquine).
- Artesunate + amodiaquine fixed-dose combination: pts weighing >40 kg should receive 4 tablets of each product per day.
Usual dose
No data. Usual dose likely.
No data. Usual dose likely.
No data. Dose post-HD on days of HD.
No data
No data
- Hepatitis: associated with use in malaria prophylaxis, higher risk than with chloroquine
- Agranulocytosis and neutropenia: associated with use in malaria prophylaxis, possibly secondary to an immunological reaction leading to greater tendency to induce agranulocytosis vs. chloroquine
- Risk of a serious adverse drug reaction with prophylactic use (which is no longer recommended) appears to be between 1 in 1000 and 1 in 5000; not clear whether risks are lower when used to treat malaria.
- Syncope, spasticity, convulsions, and involuntary movements with overdose.
- QTc prolongation (without Torsades).
CYP2C8 substrate
- Drug-drug interaction with PIs and NNRTIs unlikely.
- Rifampin may decrease amodiaquine serum concentrations.
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Plasmodium malariae; P. falciparum;P. vivax; P. ovale
- Active against chloroquine-sensitive and resistant strains of Plasmodium falciparum , although partial cross-resistance between amodiaquine and chloroquine exists.
- Artemisinin-based combination therapy (ACT) is currently WHO recommended treatment of choice for uncomplicated falciparum malaria: based on the level of resistance, in Africa, artemether-lumefantrine and artesunate + amodiaquine are the ACTs of choice; amodiaquine + sulfadoxine-pyrimethamine may be considered as an interim option in situations where ACTs cannot be made available. Amodiaquine not recommended for the prophylaxis of malaria because of resistance and risk of major toxicity.
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