Therapeutic action

– Antimalarial

Indications

– Treatment of severe falciparum malaria
– Initial treatment of uncomplicated falciparum malaria, when persistent vomiting precludes oral therapy

Forms and strengths, route of administration

– Powder for injection, in 60 mg-vial, with one 1 ml-ampoule of 5% sodium bicarbonate and one 5 mlampoule of 0.9% sodium chloride, for slow IV injection (3 to 5 minutes) or slow IM injection

– Dissolve the powder in the entire volume of 5% sodium bicarbonate and shake the vial until the solution becomes clear. Then, add the 0.9% sodium chloride into the vial:
5 ml of 0.9% sodium chloride to obtain 6 ml of artesunate solution containing 10 mg/ml, for IV injection
2 ml of 0.9% sodium chloride to obtain 3 ml of artesunate solution containing 20 mg/ml, for IM injection

Dosage and duration

– Child under 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 at least 3 doses parenterally, then, if the patient can tolerate the oral route, change to an artemisinin-based combination (do not use the combination artesunate-mefloquine if the patient developed neurological signs during the acute phase).

* Use a 1 ml syringe graduated in 0.01 ml when the dose required is less than 1 ml.
** For patients over 25 kg, a 2^nd vial must be prepared to obtain the volume needed, a 3^rd vial for patients over 50 kg and a 4^th vial for patients over 76 kg.

Contra-indications, adverse effects, precautions

– May cause: gastrointestinal disturbances, dizziness, headache, fever, muscle and joint pain, pruritus; rarely rash, QT interval prolongation, post-treatment haemolytic anaemia (especially in case of hyperparasitaemia and in young children).
– Pregnancy: no contra-indication
– Breast-feeding: no contra-indication

Remarks

– The solution should be clear, do not use if the solution is cloudy or if a precipitate is present.
– Do not use water for injection for:
 reconstitution (only use sodium bicarbonate);
 dilution (only use sodium chloride).
– Storage: below 25 °C