Artesunate
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| Clinical data | |
| AHFS/Drugs.com | International Drug Names |
| Pregnancy cat. | ? |
| Legal status | Not licensed in UK or US |
| Routes | oral, IV, IM |
| Identifiers | |
| CAS number | 83507-69-1  80155-81-3 (sodium salt) |
| ATC code | P01BE03 |
| PubChem | CID 5464098 |
| ChemSpider | 16735675  |
| UNII | 60W3249T9M |
| ChEMBL | CHEMBL258608 |
| NIAID ChemDB | AIDSNO:112081 |
| Chemical data | |
| Formula | C19H28O8 |
| Mol. mass | 384.421 g/mol |
| SMILES | eMolecules & PubChem |
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Artesunate (INN) is part of the artemisinin group of drugs that treat malaria. It is a semi-synthetic derivative of artemisinin that is water-soluble and may therefore be given by injection. It is sometimes abbreviated AS.
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[edit] Uses
Artesunate is used primarily as treatment for malaria; it has also been shown to be >90% efficacious at reducing egg production in Schistosoma haematobium infection.[1]
According to WHO intravenous AS is the drug of choice for severe malaria both in children and adults where there is low transmission.[2] In regions where transmission is high, randomized trials among Asian adults and African children strongly advocates the use of artesunate over quinine as the treatment of choice for falciparum malaria.[3] [4]
[edit] Dosing
There are no licensed forms of artesunate available in the U.S. or UK. In the UK, artesunate is available on a named patient basis only.
Intravenous dose of IV artesunate for treatment of severe malaria:
- 2.4 mg/kg loading dose over 5 minutes
- 2.4 mg/kg dose 12 hours later
- 2.4 mg/kg once daily after that
Artesunate must always be given with another antimalarial such as mefloquine[5][6] or amodiaquine[7] so as to avoid the development of resistance. The combination of artesunate/amodiaquine has been found to be equivalent to co-artemether.[8]
For severe malaria during pregnancy, the WHO recommends artesunate or quinine during the first trimester and artesunate as the first-line therapy during the second and third trimesters.[9]
[edit] Synthesis
Artesunate is prepared from dihydroartemisinin (DHA) by reacting it with succinic acid anhydride in basic medium. Pyridine as base/solvent, sodium bicarbonate in chloroform and catalyst DMAP (N,N-dimethylaminopyridine) and triethylamine in 1,2-dichloroethane have been used, with yields of up to 100%. A large scale process involves treatment of DHA in dichloromethane with a mixture of pyridine, a catalytic amount of DMAP and succinic anhydride. The dichloromethane mixture is stirred for 6–9 h to get artesunate in quantitative yield. The product is further re-crystallized from dichloromethane. alpha-Artesunate is exclusively formed (m.p 135–137˚C).
[edit] Drug resistance
Clinical evidence of drug resistance has appeared in Western Cambodia, where artemesinin monotherapy is common.[10] There are as yet no reports of resistance emerging elsewhere.
[edit] References
- ^ Boulangier D, Dieng Y, Cisse B, et al. (2007). "Antischistosomal efficacy of artesunate combination therapies administered as curative treatments for malaria attacks". Trans R Soc Trop Med Hyg 101 (2): 113–16. doi:10.1016/j.trstmh.2006.03.003. PMID 16765398.
- ^ WHO (2006). Guidelines for the treatment of malaria. World Health Organization, Geneva.
- ^ South East Asian Quinine Artesunate Malaria Trial (SEAQUAMAT) (2005). "Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial". The Lancet 366 (9487): 717–725. doi:10.1016/S0140-6736(05)67176-0. PMID 16125588. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2967176-0/abstract.
- ^ Dondorp AL, et al. (2010). "Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial". The Lancet 376 (9753): 1647–1657. doi:10.1016/S0140-6736(10)61924-1. PMC 3033534. PMID 21062666. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961924-1/abstract.
- ^ Looareesuwan S, Viravan C, Vanijanonta S, et al. (1992). "Randomised trial of artesunate and mefloquine alone and in sequence for acute uncomplicated falciparum malaria". Lancet 339 (8797): 821–4. doi:10.1016/0140-6736(92)90276-9. PMID 1347854.
- ^ Nosten F, van Vugt M, Price R, et al. (2000). "Effects of artesunate-mefloquine combination on incidence of Plasmodium falciparum malaria and mefloquine resistance in western Thailand: a prospective study". Lancet 356 (9226): 297–302. doi:10.1016/S0140-6736(00)02505-8. PMID 11071185.
- ^ Adjuik M, Agnamey P, Babiker A, et al. (2002). "Amodiaquine-artesunate versus amodiaquine for uncomplicated Plasmodium falciparum malaria in African children: a randomised, multicentre trial". Lancet 359 (9315): 1365–72. doi:10.1016/S0140-6736(02)08348-4. PMID 11978332.
- ^ Meremikwu M, Alaribe A, Ejemot R, et al. (2006). "Artemether-lumefantrine versus artesunate plus amodiaquine for treating uncomplicated childhood malaria in Nigeria: randomized controlled trial". Malar J 5: 43. doi:10.1186/1475-2875-5-43. PMC 1475595. PMID 16704735. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1475595.
- ^ WHO (2007). Assessment of the safety of artemisinin compounds in pregnancy. World Health Organization, Geneva.
- ^ White NJ (2008). "Qinghaosu (Artemisinin): The price of success". Science 320 (5874): 330–334. doi:10.1126/science.1155165. PMID 18420924.
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