Piperaquine/dihydroartemisinin

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Piperaquine/dihydroartemisinin
Combination of
PiperaquineAntimalarial
DihydroartemisininAntimalarial
Names
Trade namesDuoCotecxin, Artekin, Eurartesim, others
Other namesDihydroartemisinin/piperaquine phosphate
Clinical data
Main usesMalaria[1]
Routes of
use
By mouth
Defined daily dosenot established[2]
Legal
Legal status
  • UK: [3]
  • In general: ℞ (Prescription only)

Piperaquine/dihydroartemisinin (DHA/PPQ), sold under the brand name Eurartesim among others, is a fixed dose combination medication used in the treatment of malaria.[4] It is a combination of piperaquine and dihydroartemisinin.[4] Specifically it is used for malaria of the P. falciparum and P. vivax types.[5][6] It is taken by mouth.[5]

Side effects are uncommon.[6] Concerns include the possibility of QT prolongation.[6] Versions are available for use in children.[5] Use in early pregnancy is not recommended.[6] The two medications work by different mechanisms.[6]

Piperaquine/dihydroartemisinin was approved for medical use in Europe in 2011.[5] It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.[4] While it was available for about US$6 per treatment course, efforts are underway as of 2010 to bring the price down one dollar per course.[6] It is commercially available in Africa and Asia.[5] It has been used to treat more than 4.5 million people as of 2017.[5]

Medical uses

It is used to treat uncomplicated malaria including that due to falciparum.[1] It may also be used following injectable treatments for severe malaria.[1]

Dosage

The defined daily dose is not established.[2] In those who weight over 25 kg the dose is 2 to 10 mg/kg DHA and 16 to 27 mg/kg PPQ.[1] While in those 5 to 25 kg the dose is 10 mg/kg DHA and 20 to 32 mg/kg PPQ. Treatment is once per day for three days.[1]

Pharmacology

Dihydroartemisinin (also known as dihydroqinghaosu, artenimol or DHA) is a drug used to treat malaria. Dihydroartemisinin is the active metabolite of all artemisinin compounds (artemisinin, artesunate, artemether, etc.) and is also available as a drug in itself. It is a semi-synthetic derivative of artemisinin and is widely used as an intermediate in the preparation of other artemisinin-derived antimalarial drugs.

Piperaquine is an antimalarial drug, a bisquinoline first made in the 1960s, and used extensively in China and Indochina as prophylaxis and treatment during the next 20 years. Usage declined in the 1980s as piperaquine-resistant strains of P. falciparum arose and artemisinin-based antimalarials became available. The combination dihydroartemisinin-piperaquine is an effective antimalarial that is used widely around the world. In South-East Asia, where resistance has emerged towards both artemisinin and piperaquine, the combination is being trialed with a third drug, namely mefloquine.[7]

Piperaquine is characterized by slow absorption and a long biological half-life, making it a good partner drug with artemisinin derivatives which are fast acting but have a short biological half-life.

Society and culture

This product is available in the market of several countries:

  • Artekin (Holleykin)
  • Eurartesim (Sigma Tau; by Good Manufacturing Practices)
  • Diphos (Genix Pharma)
  • Timequin (SAMI Pharma )
  • Duocotecxin (Holley Pharm)
  • Malacur (Elder Pharmaceuticals for SALVAT Laboratories)
  • Ridmal (Ajanta Pharma Limited)

References

  1. 1.0 1.1 1.2 1.3 1.4 "DIHYDROARTEMISININ/PIPERAQUINE = DHA/PPQ oral - Essential drugs". medicalguidelines.msf.org. Retrieved 30 August 2020.
  2. 2.0 2.1 "WHOCC - ATC/DDD Index". www.whocc.no. Retrieved 11 September 2020.
  3. "Eurartesim 320 mg/40 mg film-coated tablets - Summary of Product Characteristics (SmPC)". (emc). 10 April 2017. Retrieved 2 May 2020.
  4. 4.0 4.1 4.2 World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  5. 5.0 5.1 5.2 5.3 5.4 5.5 "Eurartesim EPAR". European Medicines Agency (EMA). 17 September 2018. Retrieved 3 May 2020.
  6. 6.0 6.1 6.2 6.3 6.4 6.5 "Dihydroartemisinin/Piperaquine Application for Inclusion in the 17th WHO Model List of Essential Medicines" (PDF). WHO. November 2010. Retrieved 29 June 2017.
  7. "TRAC II - Mahidol Oxford Tropical Medicine Research Unit". www.tropmedres.ac. Archived from the original on 28 July 2017. Retrieved 28 July 2017.

External links