Lonart Artemether and Lumefantrine Dispersible Tablets

LONART® Dispersible
(Artemether 20 mg + Lumefantrine 120 mg Dispersible Tablets)

(For Infant & Children only)

 

COMPOSITION

Each dispersible tablet contains:

Artemether 20mg

Lumefantrine 120mg

Excipients q.s.

 

PROPERTIES

Artemether is the most active derivate of the Artemisinines, a new class of antimalarial drugs derived from Artemisinin. The latter compound is extracted from the plant Artemisia Annua and Artemether is prepared semi-synthetically.

Lumefantrine is a synthetic aryl amino alcohol similar to mefloquine and halo-fantrine.

 

INDICATION

Treatment of malaria in children caused by all forms of Plasmodium including acute uncomplicated malaria caused by drug resistant strains of P. falciparum.

 

PHARMACOLOGICAL PROPERTIES

Pharmacodynamics

Both components of LONART Dispersible have their own action site in the malarial parasite. The presence of the endoperioxide bridge in Artemether (generating singlet oxygen and free radicals: those are very cytotoxic to the plasmodia) appears to be essential for antimalarial activity. Morphological changes of the parasitic membranes induced by Artemether have been described, being the result of free-radical action.

Lumefantrine interferes more in the polymerization processes.

Other in vitro test suggest that both cause a marked diminution of nucleic acid synthesis. Inhibition of protein synthesis as the basic mechanism of action is suggested in studies which showed morphological changes in ribosomes as well as in the endoplasmic reticulum.

Although Artemether acts essentially as a blood schizonticide, LONART Dispersible did clear gametocytes in comparative clinical trials.

 

Pharmacokinetics

Orally administered Artemether is rapidly absorbed reaching therapeutic levels within 60-90 minutes. Artemether is metabolized in the liver to the demethylated derivate dihydroartemisinin (DHA). The elimination is rapid, with a T1/2 of 2-4 hours.

Dihydroartemisinin, being a potent antimalarial itself, has a T1/2 of about 2-4 hours. The degree of binding to plasma proteins varied markedly according to the species studied. The binding of Artemether with plasma protein in man is about 50%. Radioactivity distribution of Artemether was found to be equal between cells and plasma.

The absorption of Lumefantrine is highly influenced by lipids and food intake (from 10% by fasten to 100% at normal diet) Therefore parents should be encouraged to give the medication with some fatty food as soon as it can be tolerated.

Lumefantrine is N-debutylated in human liver microsomes. This metabolite has 5 to 8 fold higher antiparasitic effects than lumefantrine. Lumefantrine is found to be highly protein bound (95%). The elimination half life in malaria attaint patients will be 4 to 6 days. Lumefantrine and its metabolites are found in bile and faeces.

 

PHARMACEUTICAL PRECAUTIONS AND CONTRA-INDICATIONS

LONART Dispersible is contraindicated in individuals hypersensitive to Artemether and Lumefantnne. Therefore, there are no strict contra-indications for the use of Artemether in children.

Nevertheless, no correlation has been found between QTc interval prolongation and plasma concentrations of lumefantrine, caution is advised to patients who are taking drugs that are known to prolong the QT interval, such as certain antibiotics (macrolides, fluoroquinolones, imidazole) or who are predisposed to cardiac arthythmias.

It is advisable not to use drugs during pregnancy but in view of the high risk of malaria during pregnancy for mother and foetus, the responsible physician may consider it essential, as in the case of cerebral malaria, to treat a pregnant woman. Artemisinin derivatives like Artemether are the fastest acting schizontocides and rapid clearance of parasites is essential. Since LONART Dispersible has been designed for its use in children it is unlikely that this problem arises.

LONART Dispersible should not be taken during breast-feeding. Due to the long elimination half-life of lumefantrine, it is recommended that breast-feeding should not start until at least one week after stopping an Artemether/Lumefantrine combination treatment.

 

DRUG INTERACTIONS

Specific negative drug – drug interactions were not seen. Artemether potentialises the antimalarial activity of other antimalarials.

As grapefruit juice retards the metabolism of some antimalarials, it would be better not to drink grapefruit juice while taking LONART Dispersible.

 

SIDE EFFECTS

With Artemether virtually no side effect have been seen. Laboratory abnormalities such as slight rise in transaminases and a decrease in reticulocyte count are rare and transient. A lowering of sinus frequency without causing ECG changes has been noticed. At high doses transient abdominal pain, tinnitus and diarrhea have been described but a causal relationship is unclear.

Some antimalarials as halofantrine and quinine can influence the ECG pattern. Attention should be made to patients previously treated with those antimalarials. A reasonable period should be taken in account before to start a treatment with lumefantrine combinations. For those patients physicians will prescribe Artemisinin derivatives in mono therapy in case of severe paludism.

Sometimes it could be possible that the following common side effect occur; rash, check this with your doctor. Other common side effects may occur as trouble of sleeping, nausea, vomiting, diarrhea, coughing. They need medical attention when persisting.

 

RESISTANCE AND RECRUDESCENCE

Resistance of Plasmodia to artemether has not been observed. It is also unlikely to occur in view of the specific mechanism of action which is very cytotoxic for Plasmodia (opening of a peroxide bridge). An apparent resistance is sometimes seen but is mainly due to multiple broods of plasmodia developing at different times in the same patient. In controlled studies recrudescence does not exceed 10%. In case of recrudescence (renal or apparent) a new complete treatment for three days is advisable.

 

DOSAGE AND ADMINISTRATION

For Infant and Children only

Body Weigh (Age Group) Day 1 Day 2 Day 3
Morning Night Morning Night
0 hour 8 hours 24 hours 36 hours 48 hours 60 hours
5-14 Kgs (6 Month-3 years) 1 Tablet 1 Tablet 1 Tablet 1 Tablet 1 Tablet 1 Tablet

Second dose to be taken strictly after 8 hours of first dose.

After each dose give your child fatty meal or something to eat or drink.

If your child vomits within 1 hours of taking LONART Dispersible, repeat the dose and get additional tablets from your pharmacist.

Give exactly as recommended and make sure that the full 3-days treatment has been taken by your child, otherwise infection may return.

 

How to take LONART Dispersible Tablets

* Take one tablet and add to a small amount of water.

* Mix water and tablet well.

* Give now and make sure the child drinks all the medicine. Check that no tablet pieces are left in the glass. In that case, add a little more water and give it to your child to drink.

 

SHELF LIFE

2 Years from the Date of Manufacturing.

 

STORAGE

Keep in a cool and dry place, below 30°C.

 

KEEP OUT OF REACH OF CHILDREN.

 

PRESENTATION

6 Tablets strip is packed in a one mono carton and 50 mono carton are packed in a outer box.
Manufactured by

BLISS GVS PHARMA LTD.

Factory: 10, Dewan Udyog Nagar,

Aliyali, Palghar, Maharashtra – 401 404, INDIA.

Regd. Off.: 102, Hyde Park, Saki Vihar Road,

Andheri (E), Mumbai – 400 072, INDIA.