Coartem® /Riamet®
FAQs
What exactly is Coartem®/Riamet®?
What is the evidence for the efficacy of Coartem®/Riamet®?
Can I be sure that Coartem®/Riamet®is safe?
How quickly will Coartem®/Riamet® work?
I am confused about your two products. What is the difference between Riamet® and Coartem®?
You say that Coartem®/Riamet® is effective against falciparum malaria, but what about the other types of malaria?
Will Riamet®/Coartem® continue to work in the future or will resistance set in quickly?
When should I use Riamet®?
What is the dosage regimen for Riamet®?
What general issues should I discuss with travellers when prescribing Riamet® as standby emergency treatment?
Regular travellers are used to taking drugs to prevent malaria. How can I persuade them to rely on standby emergency treatment with Riamet®?
Why can't I use Riamet®/Coartem® for prophylaxis?
Should I start to treat with Coartem®/Riamet® immediately I see a patient with malaria-like symptoms, or wait until I have an accurate diagnosis?
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What exactly is Coartem®/Riamet®? |
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Coartem®/Riamet® is a fixed oral combination of two compounds - artemether and lumefantrine - and is effective against the most dangerous form of malaria (falciparum). Artemether has a rapid onset of action, but when used alone the dose has to be extended to prevent recrudescence. Lumefantrine has a slower onset of action but provides a high long-term cure rate.
When used together, the combination of artemether and lumefantrine in Coartem®/Riamet® provides rapid clearance of parasitaemia and most symptoms of malaria, coupled with prevention of recrudescence. There is currently no reported clinical resistance to either component. Coartem®/Riamet® provides an opportunity to deal with multi-drug resistant strains with a treatment that is both effective, convenient and well tolerated. |
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What is the evidence for the efficacy of Coartem®/Riamet®? |
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Coartem®/Riamet® has been extensively tested in field studies in some of the world’s most endemic regions, including those where standard antimalarial drugs no longer work effectively. Such studies show that Coartem®/Riamet®:
- clears parasites from the blood faster than most other antimalarial drugs
- clears fever very rapidly
- is at least as effective as current options even in multi-drug resistant areas, where a high level of efficacy has been maintained for up to 28 days.
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Can I be sure that Coartem®/Riamet® is safe? |
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A variety of trials indicate that Riamet®/Coartem® is very well tolerated in clinical use. This is based on the Clinical Safety Review for Coartem®/Riamet® which analysed the tolerability and safety data from 1869 patients (including 611 patients of age 12 years or less). It revealed very good safety and tolerability. Over 90% of the reported adverse events were rated mild to moderate (these could also have been attributed to the effects of malaria). There were no serious or persistent neurological side effects with Coartem®/Riamet®, no clinically relevant alterations to laboratory parameters, and no clinically relevant cardiotoxicity.10 |
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How quickly will Coartem®/Riamet® work? |
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Coartem®/Riamet® provides rapid resolution of fever, the most distressing symptom of malaria, and is one of the fastest-acting therapies available to treat falciparum malaria. It produces near total parasite reduction within 24-48 hours and can therefore prevent the progression to fatal cerebral malaria.
The rapid action of Riamet® means that it is ideal for standby emergency therapy when the patient may not have access to immediate medical diagnosis and treatment. |
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I am confused about your two products. What is the difference between Coartem®/Riamet® ? |
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Coartem® and Riamet® are two brand names for the same product sold in different parts of the world, to address different medical needs.
Coartem® is for treatment of malaria, and is intended for use in malaria-endemic areas, especially where multi-drug resistance is present.
In general, Riamet® is marketed in countries in malaria-free regions of the world for treatment of returning infected travellers. In some of these countries, it may also be registered for emergency standby use in non-immune travellers who will be visiting a malarial area, and who may be unable to get prompt access to medical care if they become infected. |
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You say that Coartem®/Riamet® is effective against falciparum malaria, but what about the other types of malaria? |
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The main focus of Coartem®/Riamet® research has been directed towards the most dangerous form of malaria (P. falciparum). Nevertheless, Coartem®/Riamet® has proved effective against P. vivax, although this parasite was present in only a small proportion of patients so far studied in clinical trials. Coartem®/Riamet® may be useful in mixed infections, which are increasingly common, there is not enough clinical data to be certain of this. |
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Will Coartem®/Riamet® continue to work in the future or will resistance set in quickly? |
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Despite many millions of treatments, no clinical resistance has emerged. As with any antimalarial drug, it is very important that Coartem®/Riamet® is used in such a way that the development of resistance is prevented or at least delayed. Coartem®/Riamet® must always be prescribed at the correct dosage, and the patient must take the full 6 doses. This will ensure parasite eradication, avoid a relapse of malaria and minimise exposure to the drug.
Used with care, Coartem®/Riamet® can continue to save lives, reduce resistance development to other drugs and reduce malaria morbidity for many years to come. |
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When should I use Riamet®? |
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Riamet® is designed for treating malaria in non-immune travellers returning from malaria-endemic areas. In some countries, it may be registered for prescription for patients to take with them on journeys to malaria-endemic areas to use as emergency treatment when no medical attention is available within 24 hours of the appearance of symptoms. Appropriate follow-up treatment is essential. In the standby indication, it must be combined with effective patient education on the symptoms of malaria. It is not a substitute for routine prophylaxis (where this is appropriate), or for routine measures to avoid mosquito bites.
See also:
Advising travellers
Understanding malaria |
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What general issues should I discuss with travellers when prescribing Riamet® as standby emergency treatment? |
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- Educate patients in the recognition of key symptoms.
- Highlight the need to follow the detailed dosage instruction on the package leaflet.
- Point out to patients that medical attention is always preferable, if available.
- Fever will clear within 24 hours but stress that treatment must be continued to completion of the prescribed course. If treatment is interrupted, a relapse can occur.
- Emphasise the need for urgent medical consultation and follow-up of malaria, even after treatment with Riamet®.
- Advise on the need to avoid mosquito bites and preventives measures: use of insecticide-impregnated bed nets and repellents.
See also:
Advising travellers
Signs and symptoms of malaria |
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Regular travellers are used to taking drugs to prevent malaria. How can I persuade them to rely on standby emergency treatment with Riamet®? |
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Many travellers dislike the side effects from prophylaxis and will welcome the opportunity to use Riamet® as an emergency treatment in areas of low risk, because it has few side effects. Treatment times are short and the drug is easy to use. Note that prophylaxis is no longer recommended by the WHO for visitors to some endemic countries where transmission is low.
In areas of high transmission and/or multi-drug resistance, travellers should be warned that chemoprophylaxis may not be reliable. In these circumstances, taking Riamet® with them in case of emergencies is a sensible precaution, in addition to routine prophylaxis.
See also:
Using Riamet®/Coartem® |
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Why can't I use Coartem®/Riamet® for prophylaxis? |
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Overuse of a drug for prophylaxis is the most effective way to shorten the life cycle of a new and effective antimalarial. Reserve the use of Coartem®/Riamet® for acute treatment only, because its useful life can be conserved if exposure to the parasites is limited.
Furthermore, the half-life of the artemether is too short for it to be used as a prophylactic. |
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Should I start to treat with Coartem®/Riamet® immediately I see a patient with malaria-like symptoms, or wait until I have an accurate diagnosis? |
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Presumptive treatment is generally discouraged in all forms of medicine, and is particularly inappropriate when there is a severe risk of the development of immunity to therapeutic drugs. However, the potentially life-threatening effects of falciparum malaria are such that you may make a clinical judgement to prescribe Coartem®/Riamet® or another antimalarial as a precaution. This judgement needs to be made in the light of the area in which the infection was acquired, and the degree of risk anticipated. Ensure that your preliminary diagnosis is confirmed as soon as possible in case alternative treatment is required.
It is preferred that Coartem®/Riamet® be used once the diagnosis of falciparum malaria is confirmed.
See also Diagnosing malaria in travellers |
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