Artesunate/ Sulfamethoxypyrazine/ Pyrimethamine

• Artesunate: 100 mg
• Sulfamethoxypyrazine: 500 mg
• Pyrimethamine: 25 mg

• Take one tablet daily for 3 days, with food to minimize stomach upset.
• Do not skip doses—complete the full treatment even if symptoms resolve early.
• Swallow whole; do not chew or crush unless advised.
• Store in a cool, dry place away from light.

Artesunate:

• Rapid-acting artemisinin derivative
• Produces free radicals that damage parasite proteins
• Short half-life; reduces parasite biomass quickly

Sulfamethoxypyrazine:

• Long-acting sulfonamide
• Inhibits dihydropteroate synthase, blocking folate synthesis in the parasite

Pyrimethamine:

• Inhibits dihydrofolate reductase, preventing DNA synthesis

Combination action:

• Artesunate clears parasites quickly.
• Sulfamethoxypyrazine and pyrimethamine sustain antimalarial effect and prevent recrudescence by blocking parasite replication.

Common:

• Nausea, vomiting
• Dizziness
• Headache
• Abdominal discomfort
• Loss of appetite

Serious (rare):

• Allergic reactions (e.g., rash, anaphylaxis)
• Hepatotoxicity
• Blood disorders (anemia, leukopenia, thrombocytopenia)
• Stevens-Johnson Syndrome

• Hypersensitivity to artesunate, sulfonamides, or pyrimethamine
• Severe hepatic or renal impairment
• Pre-existing blood disorders
• First trimester of pregnancy, unless life-saving

• Folate antagonists (e.g., methotrexate, trimethoprim): Increased risk of folate deficiency.
• Sulfonylureas: Risk of hypoglycemia.
• Phenytoin and other anticonvulsants: May alter blood levels.
• Other hepatotoxic drugs: Additive bone marrow suppression.
• Antiretrovirals: May have interactions—monitor closely.