Antimalarial Drug Toxicity: A Review

  title={Antimalarial Drug Toxicity: A Review},
  author={Hussien O. Alkadi},
  pages={385 - 391}
Antimalarial drug toxicity is viewed differently depending upon whether the clinical indication is for malaria treatment or prophylaxis. In the treatment of Plasmodium falciparum malaria, which has a high mortality if untreated, a greater risk of adverse reactions to antimalarial drugs is inevitable. As chloroquine resistance has become widespread, alternative agents may be used in treatment regimens, however, the toxicity of these antimalarial agents should be considered. Quinine is the… 

Pharmacodynamics of antimalarial chemotherapy

Treatment of malaria in pregnant women requires special attention in light of limited treatment options caused by potential teratogenicity coupled with a paucity of safety data for the mother and fetus, and key advantages of artemisinins over the conventional antimalarials include their rapid and potent action, with good tolerability profiles.

Adverse neuropsychiatric effects of antimalarial drugs

A more systematic approach to assess the neuropsychiatric adverse effects of new or repurposed antimalarial drugs on their safety, tolerability and efficacy phases of clinical studies and in post-marketing surveillance, is needed to ensure that these life-saving tools remain available and can be prescribed with appropriate caution and medical judgment.

The pharmacogenetics of antimalaria artemisinin combination therapy

  • R. PiedadeJ. Gil
  • Medicine, Biology
    Expert opinion on drug metabolism & toxicology
  • 2011
Advances in the understanding of antimalarial pharmacogenetics are urgent in order to protect the exposed populations, enhance the effectiveness of ACT and, consequently, contributing for the long aimed elimination of the disease.

Pharmacotherapy for the prevention of malaria in pregnant women: currently available drugs and challenges

The present review summarizes currently available therapies, emerging candidate combination therapies, and the potential challenges to integrating these into mainstream policy.

Tafenoquine: a toxicity overview

This systematic review assesses tafenoquine associated adverse events in English-language, human clinical trials and concludes that there is no convincing evidence for neurologic, ophthalmic, and cardiac toxicities, and the optimal radical curative regimen including the tafanoquine dose along with its safety for parts of Southeast Asia, South America, and Oceania needs further assessment.

Current status of malaria chemotherapy and the role of pharmacology in antimalarial drug research and development

With major advances in understanding of malaria parasite biology coupled with the completion of the malaria genome, has presented exciting opportunities for target‐based antimalarial drug discovery.

Rectal artemisinins for malaria: a review of efficacy and safety from individual patient data in clinical studies

The more rapid parasite clearance of single high-dose regimens suggests that achieving immediate high drug concentrations may be the optimal strategy for severe malaria treatment.

Toxicity of the antimalarial artemisinin and its dervatives

The lesson learned from animal and human studies is that long-term availability rather than short-term peak concentrations of artemisinins cause toxicity, which explains why considerable toxicities were found in the majority of animal experiments, but not in human studies.

Surveillance for adverse drug reactions to combination antimalarial therapy with sulfadoxine-pyrimethamine plus artesunate in Peru.

Treatment of uncomplicated malaria with SP-AS was associated with a low frequency of mild adverse effects in Peru, and therefore should be considered as a first-line therapy in areas of the Americas where SP efficacy is still high.

Artemisinin‐based combination therapies for uncomplicated malaria

The goal of potent, safe, easy‐to‐administer and inexpensive ACTs may see trioxolanes in place of artemisinin derivatives, as well as novel partner drugs such as pyronaridine or naphthoquine, in the future.



Adverse Effects of Antimalarials

A careful risk-benefit analysis is required to balance therisk of acquiring potentially serious malaria against the risk of harm from the prophylactic agent, because the information needed to perform accurate analyses of this type is not available for most antimalarials.

Antimalarial Drug Toxicity

The most important class of drugs that could have a major impact on malaria control is the artemisinin derivatives, which have remarkable efficacy and an excellent safety record and only very rarely produce allergic reactions.

CNS Adverse Events Associated With Antimalarial Agents

CNS adverse drug events are dramatic, and case reports have influenced clinical opinion on the use of antimalarials, and data do not suggest a need to diminish the correct use of the quinoline and artemisinin derivatives.

Mefloquine. A review of its antimalarial activity, pharmacokinetic properties and therapeutic efficacy.

Mefloquine is generally well tolerated in both adults and children, with nausea, vomiting, diarrhoea, headache, dizziness, rash, pruritus and abdominal pain being the most common adverse effects, although it is difficult to distinguish between disease- and treatment-related events.

Safety evaluation of the drugs available to prevent malaria

The existing knowledge base for the safety of drugs currently used to prevent malaria is described along with present designs for future studies that would allow a rigorous safety assessment of candidate chemoprophylactic agents and of new drugs introduced to Prevent malaria.

Malarone (atovaquone and proguanil hydrochloride): a review of its clinical development for treatment of malaria. Malarone Clinical Trials Study Group.

Treatment with atovaquone and proguanil hydrochloride was significantly more effective than mefloquine (Thailand), amodiaquine (Gabon), chloroquine(Peru and the Philippines) or chloroquines plus pyrimethamine/sulfadoxine (Philippines), in clinical trials where the comparator drug was highly effective.

Quinine toxicity.

Clinically, quinine poisoning is observed in 3 situations: self-poisoning; accidentally; and following use of quinines in excessive doses in the hope of achieving abortion.

An integrated assessment of the clinical safety of artemether-lumefantrine: a new oral fixed-dose combination antimalarial drug.

Mefloquine for malaria chemoprophylaxis 1992-1998: a review.

Cumulative evidence suggests a high protective efficacy of mefloquine (>91%) in nonimmune travelers to areas of chloroquine resistant Plasmodium falciparum (CRPF) except for clearly defined regions of multi-drug resistance.

Treatment of Malaria tropica with a Fixed Combination of Rifampicin, Co-Trimoxazole and Isoniazid: A Clinical Study

A fixed combination of rifampicin, co-trimoxazole and isoniazid (CotrifazidTM, CF) was found to be highly effective for the treatment of malaria tropica in a 14-day trial in Kenya.