Therapeutic Action
Antimalarial
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Drug reference
Antimalarial
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Treatment of severe malaria Initial treatment of uncomplicated malaria, when persistent vomiting precludes oral therapy
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May cause: gastrointestinal disturbances, dizziness, headache, fever, muscle and joint pain, pruritus; rarely rash, delayed haemolytic anaemia (appearing 2 to 3 weeks after treatment, especially in case of hyperparasitaemia and in young children). Pregnancy and breast-feeding: no contra-indication
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Powder for injection (artesunate), 60 mg vial, plus Solvent: 2% arginine + 0.84% sodium bicarbonate (NaHCO ), 3 ml ampoule 3 For reconstitution: Add the entire ampoule of solvent into the vial, to obtain 3 ml of solution containing 20 mg of artesunate per ml. Shake the vial gently until the powder is dissolved. Use when the solution is clear. Administer by slow IV (3 to 5 minutes) or slow IM injection. NEVER ADMINISTER BY IV INFUSION.
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Child under 6 kg: seek specialist advice. Child from 6 to < 20 kg: 3 mg/kg/dose Child 20 kg and over and adult: 2.4 mg/kg/dose One dose on admission (H0) then 12 hours after admission (H12) then 24 hours after admission (H24) then, once daily. Administer for at least for 24 hours (minimum 3 doses), then, if the patient can tolerate the oral route, change to a full 3-day course of an artemisinin-based combination (ACT). If not, continue parenteral treatment with one dose daily until the patient can tolerate the oral route (do not exceed 7 days of parenteral treatment). The first dose of ACT should be taken 8 to 12 hours after the last injection of artesunate. For information (WHO weight-based dosage): Artesunate (arginine/NaHCO solvent) 20 mg/ml solution for IV or IM 3 Weight Dose per Dose per Weight Dose per Dose per injection (mg) injection injection injection (ml) (mg) (ml) Child 6 to < 20 kg 6 to < 7 kg 14 to < 17 kg 20 mg 1 ml 50 mg 3 ml 7 to < 11 kg 30 mg 2 ml 17 to < 20 kg 60 mg 3 ml 11 to < 14 kg 40 mg 2 ml ─ ─ ─ Child ≥ 20 kg and adult 20 to < 26 kg 60 mg 3 ml 55 to < 59 kg 140 mg 7 ml 26 to < 30 kg (a) 70 mg 4 ml 59 to < 63 kg 150 mg 8 ml 30 to < 34 kg 63 to < 67 kg 80 mg 4 ml 160 mg 8 ml 34 to < 38 kg 90 mg 5 ml 67 to < 71 kg 170 mg 9 ml 38 to < 42 kg 100 mg 5 ml 71 to < 76 kg 180 mg 9 ml (a) 42 to < 46 kg 110 mg 6 ml 190 mg 10 ml 76 to < 80 kg 46 to < 51 kg 120 mg 6 ml 80 to < 84 kg 200 mg 10 ml (a) 130 mg 7 ml 84 to < 88 kg 210 mg 11 ml 51 to < 55 kg nd rd a For patients over 26 kg, a 2 vial must be prepared to obtain the volume needed, a 3 vial for patients th over 51 kg and a 4 vial for patients over 76 kg.
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The solution should be clear, do not use if the solution is cloudy or if a precipitate is present. Artesunate 60 mg 1-step formulation and artesunate 2-step formulation are bioequivalent and can be used interchangeably during the course of a treatment. For preparation, use only the solvent/diluent provided by the manufacturer for each formulation. However, to avoid confusion and reduce the risk of preparation errors, it is recommended to use only one formulation per patient per treatment course.
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– Below 30 °C Once reconstituted, the solution must be used immediately.
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2.4 mg/kg/dose
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