Coartem (Artemether + Lumefantrine)
Also sold as: Coartem, Artefan, Lumether, AL-combo, Riamet
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Tablet: Artemether 20mg + Lumefantrine 120mg (co-formulated) +1
Indications
- Uncomplicated Plasmodium falciparum malaria (first-line WHO/NVBDCP recommendation for non-severe falciparum malaria)
- Mixed species malaria (falciparum + vivax)
Adult Dosing
Uncomplicated P. falciparum malaria
4 tablets (artemether 80mg + lumefantrine 480mg) PO at 0, 8, 24, 36, 48, 60 hours (6 doses over 3 days)
Take with food or fatty drink (milk, biscuit, banana) — lumefantrine absorption increased 16× with fat. If vomiting within 30 min of dose, repeat that dose.
Pediatric Dosing
Dispersible tablets for small children — mix in water and administer immediately. Can be taken with breast milk.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any CrCl | No dose adjustment required |
Hepatic Adjustment
Use with caution in significant hepatic impairment — both drugs hepatically metabolised
Pregnancy & Lactation
Pregnancy: Category C
2nd/3rd trimester: safe (WHO-recommended ACT for falciparum in 2nd/3rd trimester). 1st trimester: quinine + clindamycin preferred (ACT use in 1st trimester — insufficient safety data though growing evidence supports safety). Benefits of treating malaria outweigh risks in pregnancy.
Lactation: Caution
Excreted in breast milk — limited data. WHO considers AL acceptable during breastfeeding. Continue breastfeeding during malaria treatment.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| QT-prolonging drugs (haloperidol, quinidine, amiodarone, antipsychotics, macrolides) | Both artemether and lumefantrine prolong QT — additive risk; avoid combination. ECG if concurrent use unavoidable. | Major |
| CYP3A4 inhibitors (ketoconazole, ritonavir) | Increase lumefantrine levels — potential QT prolongation | Major |
| CYP3A4 inducers (rifampicin, carbamazepine, phenytoin) | Dramatically reduce lumefantrine levels — treatment failure risk; avoid combination | Major |
| Grapefruit juice | Increases lumefantrine exposure — avoid during treatment | Moderate |
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Side Effects
Common
- Headache
- Anorexia
- Dizziness
- Nausea and vomiting
- Abdominal pain
- Arthralgia/myalgia
- Sleep disturbances
- QT prolongation (usually subclinical)
Serious / Discontinue If
- QT prolongation (clinical significance at standard doses is low but documented)
- Cardiac arrhythmias (at excessive doses or with QT drugs)
- Severe anaemia (from malaria — not drug)
Contraindications
- Known hypersensitivity to artemisinin or lumefantrine
- Concurrent QT-prolonging drugs
- Severe malaria (use parenteral artesunate — not AL)
- First trimester (relative — quinine preferred)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Coartem 20/120mg | Novartis | 24 tab ₹285 |
| Artefan 20/120mg | Ajanta Pharma | 24 tab ₹225 |
| Lumether 20/120mg | Cipla | 24 tab ₹215 |
Monitoring Required
- Parasitaemia clearance (blood film at Day 3, Day 7 — WHO recommends Day 28 cure rate monitoring)
- Haemoglobin (at Day 14 — anaemia recovery)
- ECG if cardiac risk factors or concurrent QT drugs
- Clinical symptom resolution (fever, rigors)
Patient Counseling Points
- ⚠️ MUST take with food or fatty drink — absorption dramatically reduced without fat (milk, biscuit, fatty food)
- If you vomit within 30 minutes of a dose — take the dose again
- Complete all 6 doses over 3 days — do not stop early even if feeling better (prevents treatment failure and resistance)
- Mosquito net and repellent even during treatment — prevent reinfection
- Return to doctor if fever returns within 28 days — possible treatment failure or new infection
- Children: dispersible tablets can be crushed in a small amount of water or breast milk
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Clinically reviewed by: Dr. Rajesh Kulkarni, MD (Infectious Diseases), Consultant Infectious Disease Specialist
Last reviewed: 2026-04-01
References
- WHO Malaria Treatment Guidelines 2022
- NVBDCP National Drug Policy for Malaria India 2023
- BNF — Artemether with Lumefantrine
- Lancet — ACT Efficacy Meta-analysis