INDICES> Artmisinin

[<ashanti.gta@mwanza.com>]

I have had several patients of late with malaria who have come in using
a drug that I am unable to locate in any reference source available 
to me. I wondered if you had come across it or had any further information on
its use and safety.

the drug trade name is:
Cotexin
(Dihydroartemisinin tablets)
composition: eight hydro-3,6,9-trimethyl-3,
12-epoxy-12H-prano-[4,3,-J]-1,2-benzodioxopine-10 (3H)-ol

Pharmacology: Powerful plasmodicide.

Absorbtion: Rapid and complete with oral dosage of 2mg/kg, Tmax=1.33h ,
Cmax=0.71ug/ml , T1/2=1.57hrs.

Indicated for all forms of severe malaria including multidrug resistant
malaria.

Dosage: starting dose for adults 120mg followed by 60mg/ day for 6 days.

Side effects: nil

Contraindications: 1st trimester of pregnancy.

and it is produced by: Beijing COTEC new Technology Corp. P.R. China

I hope to hear from you soon.
Regards Brian.

the info that I have on artemisinin is as follows:

Artemisinin is a potent and rapidly acting blood schizonticide, which
is isolated from Artemisia annua, a herb used in cHina for the
treatment of malaria.

Artemisinin and its derivatives dihydroartemisinin and sodium 
artesuanate are used alone or in combination with other antimalarials
(in China and the Far East) for the treatment of malaria resistant to
conventional drugs. These compounds are currently  undergoing clinical
trials.

The main advantage of these compounds is their speed of action.  they
produce more rapid clearance of parasites than quinine, chloroquine,
sulphadoxine/pyrimethamine or mefloquine in the tretament of
falciparum malaria.  

Although artesuanate and artemether have shown to be effective in the
treatment of severe and complicated malaria, the WHO has recommended
that these compounds be reserved for malaria unresponsive to
conventional drugs in an attempt to delay the development of
resistance.  For uncomplicated multidrug resistant malaria the WHO
recommends that these compounds be administered orally in combination
with mefloquine for a minimum of 3 days.  If used alone they should be
used for a minimum of 5 days.  For severe malaria unresponsive to
quinine, the WHO recommends the use of parenteral, or possibly rectal
formulations with the addition of a therapeutic dose of mefloquine to
ensure radical cure. 

Safety:
Treatment with artemisinin and its derivatives appears to be well
tolerated.  However evidence of severe neurotoxicity has been seen in
ANIMALS with high doses.  Bradycardia has also been reported.

Further safety data should be forthcoming after clinical trial data is
made available/ published.

reference:
Martindale 31st edition, Page 461.

Can any INDICES members add to this ??
many thanks
Leesette - moderator
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