Antimalarial

Product Details:

Indications:

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

Dosage:

• Adult dose- 80mg twice a day one day 1, followed by 80mg once a day for 4 days. Max dose-480mg.
• Children- 1.6mg/kg twice a day on day 1, follwed by same dose once daily for 5 days. Max dose-9.6mg/kg A 3 day regime is also used alternatively.

Product Details:

Indications:              

• P.falciparum malaria especially in quinidine-resistant patients.

Dosage:

• Adults and children over 6 months: 5 mg/kg orally on the first day followed by 2.5 mg/kg on the second and third days in combination with mefloquine (15 mg/kg) in a single dose on the second day. In a few areas, a higher dose (25 mg/kg) of mefloquine may be required for a cure to be obtained.

Product Details:

Indications:

• For the treatment of acute attacks of malaria, including attacks due to chloroquine-resistant or multi-drug-resistant strains of Plasmodium falciparum.
• Quinine is used parenterally for cerebral, severe or complicated malaria, or when vomiting prevents retention of an orally administered drug.
• Quinine dihydrochloride is the salt usually employed for the preparation of injections.

Dosage:

• Adult: As diHCl: Initially, 20 mg/kg to max 1.4 g over 4 hr w/ maintenance infusion started after 8 hr. Maintenance infusions: 10 mg/kg to max 700 mg over 4 hr 8 hrly. Loading dose should not be given if patient received quinine, quinidine, halofantrine or mefloquine during the previous 12 hr.
• Child: ≤5 mg/kg/hr by slow IV infusion.

Product Details:

Indications:

• Chloroquine resistant falciparum malaria acute attack.
• This medication is an antimalarial agent, prescribed for treatment of falciparum malaria, resistant to chloroquine. It blocks the formation of folinic acid within the malaria organism, which kills the parasite. 

Dosage:

• Adult: Per tab contains pyrimethamine 25 mg and sulfadoxine 500 mg: 2-3 tabs as a single dose. Do not repeat for at least 7 days.
• Child: Pyrimethamine 25mg + Sulfadoxine 500mg (Tablet): <2 yr (5-10 kg): ½ tab as a single dose; 2-5 yr (>10-20 kg): 1 tab as a single dose; 5-10 yr (< 20-30 kg): 1½ tab as a single dose; 10-14 yr (> 30-45 kg): 2 tab as a single dose. Do not repeat for at least 7 days. 

Product Details:

Indications:  

• Chloroquine resistant malaria,
• Complicated falciparam malaria
• Cerebral malaria.

Dosage:

• Adult: Due to Plasmodium falciparum: 150 mg once daily for 3 consecutive days.
• Children - 3mg/Kg per day administered by intramuscular injection over a 3-day period.

Product Details:

Indications:              

• Artemether & Lumefantrine is indicated for the treatment of acute uncomplicated Plasmodium falciparum malaria in adults, children and infants of 5 kg and above.
• Consideration should be given to official guidance regarding the appropriate use of antimalarial agents.

Dosage:

Adults and children weighing 35 kg and above:

• For patients 12 years of age and above and 35 kg body weight and above, a course of treatment comprises six doses of four tablets i.e. total of 24 tablets, given over a period of 60 hours as follows: the first dose of four tablets, given at the time of initial diagnosis, should be followed by five further doses of four tablets given at 8, 24, 36, 48 and 60 hours thereafter.

Children and infants weighing 5 kg to less than 35 kg:

A six-dose regimen is recommended with 1 to 3 tablets per dose, depending on bodyweight:

• 5 to less than 15 kg bodyweight: the first dose of one tablet, given at the time of initial diagnosis, should be followed by five further doses of one tablet given at 8, 24, 36, 48 and 60 hours thereafter.
• 15 to less than 25 kg body weight: the first dose of two tablets, given at the time of initial diagnosis, should be followed by five further doses of two tablets given at 8, 24, 36, 48 and 60 hours thereafter.
• 25 to less than 35 kg bodyweight: the first dose of three tablets, given at the time of initial diagnosis, should be followed by five further doses of three tablets given at 8, 24, 36, 48 and 60 hours thereafter.

Method of administration:

• Tablets for oral administration.
• To increase absorption, Artemether & Lumefantrine should be taken with food or a milky drink .If patients are unable to tolerate food, Artemether & Lumefantrine should be administered with water, but the systemic exposure may be reduced. Patients who vomit within 1 hour of taking the medication should repeat the dose.
• For administration to small children and infants, the tablet/s may be crushed.

Product Details:

Indications:              

• Artesunate has an antimalrial activity.
• It can quickly and reliably control the actute attack and cerebral type of malaria. It is effective against plasmodium falciparum and plasmodium vivax, especially against malaria parasites resistant to Chlorquine. falciparum malaria.

Dosage:

• Adult & Child: 2.4 mg/kg via IM or IV admin. Repeat 12 hr and 24 hr later, then once daily thereafter.

The usual injection dosage for each time:

• Adult and Children >
• 7 years: 1.2mg/kg.
• Children < 7 years: 1.5mg/kg.

The following doses are given at hour 4 and 24 after the first injection in day 1. Give 1 dose daily for the consecutive days. A course of therapy is recommended for 5 consecutive days.

Product Details:

Indications:   

• Atovaquone/Proguanil Hydrochloride is a fixed dose combination of atovaquone and proguanil hydrochloride which acts as a blood schizonticide and also has activity against hepatic schizonts of Plasmodium falciparum. It is indicated for:
• Prophylaxis of Plasmodium falciparum malaria.
• Treatment of acute, uncomplicated Plasmodium falciparum malaria.
• Because Atovaquone/Proguanil Hydrochloride is effective against drug sensitive and drug resistant P. falciparum it is especially recommended for prophylaxis and treatment of P. falciparum malaria where the pathogen may be resistant to other antimalarials.

Dosage:

Prophylaxis:

• Commence 24 or 48 hours prior to entering a malaria-endemic area
• Continue during the period of the stay
• Continue for 7 days after leaving the area
• In residents (semi-immune subjects) of endemic areas, the safety and effectiveness of Atovaquone/Proguanil Hydrochloride has been established in studies of up to 12 weeks.
• In non-immune subjects, the average duration of exposure in clinical studies was 27 days.

Dosage in Adults:

• One Atovaquone/Proguanil Hydrochloride film-coated tablet daily.
• Atovaquone/Proguanil Hydrochloride is not recommended for malaria prophylaxis in persons under 40 kg bodyweight. Other pharmaceutical strengths may be more appropriate for malaria prophylaxis in persons weighing under 40 kg.

Treatment:

Adults:

• Four Atovaquone/Proguanil Hydrochloride film-coated tablets as a single dose for three consecutive days.

Elderly:

• A pharmacokinetic study indicates that no dosage adjustments are needed in the elderly

Hepatic Impairment:

• A pharmacokinetic study indicates that no dosage adjustments are needed in patients with mild to moderate hepatic impairment. Although no studies have been conducted in patients with severe hepatic impairment.

Renal Impairment:

• Pharmacokinetic studies indicate that no dosage adjustments are needed in patients with mild to moderate renal impairment. In patients with severe renal impairment (creatine clearance <30 mL/min) alternatives to Atovaquone/Proguanil Hydrochloride for treatment of acute P. falciparum malaria should be recommended whenever possible.

Method of administration:

• The daily dose should be taken with food or a milky drink (to ensure maximum absorption of Atovaquone) at the same time each day.
• If patients are unable to tolerate food, Atovaquone/Proguanil Hydrochloride should be administered, but systemic exposure of atovaquone will be reduced.

Children: 

Product Details:

Indications:              

• Chloroquine injection is used in acute attacks of malaria when the patient is unable to swallow.

Dosage:    

• Adult: 200 to 300 mg chloroquine base by intramuscular or intravenous injection. It should not be given intravenously to children.   
• Adults: PO- Initial dose is 600 mg, then 300mg 6hours later and 300mg every day for 2 days.
• Children: PO- Initial dose is 10 mg/kg, then 5mg/kg 6hours later and 5 mg/kg every day for 2 days.

Product Details:

Indications:

• Acute malaria
• Prophylaxis of malaria
• Discoid and systemic lupus erythematosus
• Hepatic amoebiasis
• Rheumatoid arthritis

Dosage:

Acute malaria:

• Adult: As base: Initially, 600 mg followed by 300 mg 6-8 hr later on day 1. On days 2 and 3, single doses of 300 mg/day.
• Child: Initially, 10 mg base/kg (max 600 mg base) followed by 5 mg base/kg (max 300 mg base) after 6 hrs. Single doses of 5 mg base/kg on days 2 and 3.

Prophylaxis of malaria:

• Adult: As base: 300 mg once wkly, starting 1 wk before exposure, continuing throughout on a wkly basis and for at least 4 wk after exposure.
• Child: 5 mg/kg weekly.

Discoid and systemic lupus erythematosus:

• Adult: As base: Initially, 150 mg once daily, reduce gradually after maximal response. Max dose: 2.5 mg/kg daily.
• Child: 3 mg/kg daily.

Hepatic amoebiasis:

• Adult: As base: 600 mg daily for 2 days then 300 mg daily for 2 or 3 wk given with emetine or dehydroemetine.
• Child: 6 mg/kg daily. Max dose: 300 mg daily.

Rheumatoid arthritis:

• Adult: As base: 150 mg daily. Max: 2.5 mg/kg daily. Discontinue treatment if there is no improvement after 6 mth.
• Child: Up to 3 mg/kg/day. Discontinue treatment if there is no improvement after 6 mth.

Product Details:

Indications:              

• Rheumatoid arthritis
• Discoid and systemic lupus erythematosus
• Prophylaxis of malaria
• Acute malaria

Dosage:

Rheumatoid arthritis; Discoid and systemic lupus erythematosus:

• Adult: Initially, 400 mg daily as single or in 2 divided doses. Maintenance: 200-400 mg daily, according to response. Max: 6.5 mg/kg/day or 400 mg daily, whichever is lower.
• Child: Up to 6.5 mg/kg daily or 400 mg daily, whichever is lower.

Prophylaxis of malaria:

• Adult: Initially, 400 mg once wkly, 2 wk before exposure and continued until 8 wk after exposure. Alternatively, if 2-wk lead-in period is not possible, 800 mg as loading dose in 2 divided doses 6 hr apart, then 400 mg once wkly continued until 8 wk after exposure. All doses should be taken on same day of each wk.
• Child: 6.5 mg/kg once wkly, 2 wk before exposure and continued until 8 wk after exposure. Alternatively, if 2-wk lead-in period is not possible, 13 mg/kg as loading dose in 2 divided doses 6 hr apart, then once wkly treatment for 8 wk after exposure. All doses should be taken on same day of each wk.

Acute malaria:

• Adult: Initially, 800 mg, then 400 mg after 6-8 hr and a further 400 mg once daily for 2 succeeding days. Alternatively, 800 mg as single dose.
• Child: Initially, 13 mg/kg as single dose then 6.5 mg/kg after 6, 24 and 48 hr.

Product Details:

Indications:              

• Proguanil Hydrochloride is an effective antimalarial agent. It is recommended for the prevention and suppression of malaria.

Dosage:

• Non-immune subjects entering a malarious area are advised to begin treatment with Paludrine 1 week before, or if this is not possible, then at least 2 days before entering the malarious area. The daily dose of Paludrine should be continued throughout exposure to risk and for 4 weeks after leaving the area.

Adults:

• Two tablets (200 mg) daily.

Paediatric population:

• Under 1 year:    1/4 tablet (25 mg) daily
• 1 to 4 years:    1/2 tablet (50 mg) daily
• 5 to 8 years:    1 tablet (100 mg) daily
• 9 to 14 years:    1 1/2 tablets (150 mg) daily
• Over 14 years:    Adult dose daily

The daily dose is best taken with water, after food, at the same time each day.
Provided the tablet fragment gives the minimum amount specified, precise accuracy in children's dosage is not essential since the drug possesses a wide safety margin.

For a young child, the dose may be administered crushed and mixed with milk, honey or jam.

Older people: There are no special dosage recommendations for the elderly, but it may be advisable to monitor elderly patients so that optimum dosage can be individually determined.

Renal Impairment: Based on a theoretical model derived from a single dose pharmacokinetic study, the following guidance is given for adults with renal impairment.

Product Details:

Indications:              

• Treatment of falciparum (malignant tertian) malaria.
• Treatment and prevention of nocturnal leg cramps in adults and the elderly, when cramps cause regular disruption of sleep.

Dosage:

For the treatment of falciparum (malignant tertian) malaria:

• Adults (including elderly) and children aged 12 years and over: 600mg every eight hours for 7 days. The dose may depend upon the size of the patient, severity of infection, and evidence of renal or liver disease (when the intervals should be increased), due to a prolonged half-life of the drug.
• If quinine resistance is known or suspected on completion of the course additional treatment may be given. This may be one of the following:
• 1. doxycycline 200mg daily (as a single dose or in 2 divided doses) for at least 7 days.
• 2. clindamycin 300mg four times daily for 5 days.
• Children aged 11 years and under: 10mg/kg every eight hours for 7 days.

For the treatment and prevention of nocturnal leg cramps:

Adults (including elderly):

• The recommended dose is 200mg at bedtime. The maximum dose is 300mg.
• A reduction in frequency of leg cramps may take up to 4 weeks to become apparent. Patients should be monitored closely during the early stages of treatment for adverse effects. After an initial trial of 4 weeks, treatment should be stopped if there is no benefit. Treatment should be interrupted at approximately three monthly intervals to assess the need for continuation of treatment with quinine.