Artesunate/ Pyronaridine

• Fixed-Dose Tablet Strengths:
• 60 mg artesunate + 180 mg pyronaridine (per tablet)
• Pediatric formulations (e.g., granules) also exist, based on regional availability.

• Take with food to improve absorption and reduce GI upset.
• Complete 3-day course, even if symptoms improve earlier.
• Monitor liver function if available, especially if treatment exceeds 1 cycle.

• Mechanism of Action:
• Artesunate: Rapid action against blood-stage parasites via free radical generation.
• Pyronaridine: Interferes with heme detoxification in the parasite, similar to other quinoline antimalarials.
• Synergistic Action: Artesunate acts quickly, and pyronaridine offers sustained effect to clear remaining parasites and reduce relapse.

Common:

• Nausea, vomiting
• Abdominal pain
• Headache
• Dizziness
• Elevated liver enzymes (transaminases)

Less common but important:

• Transient hepatotoxicity (ALT/AST elevation—monitor liver function)
• QT prolongation (rare)

• Hypersensitivity to artesunate or pyronaridine
• Significant hepatic impairment
• History of liver enzyme elevation with prior use
• QT prolongation or use of other QT-prolonging drugs

• Hepatotoxic drugs: Increased risk of liver injury
• QT-prolonging agents: Additive risk of cardiac arrhythmia
• Antiretrovirals, antibiotics: Potential CYP enzyme interaction—monitor clinically