Pharmacokinetic interactions of antimalarial agents.

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Giao PT, de Vries PJ

Pharmacokinetic interactions of antimalarial agents.

Clin Pharmacokinet. 2001;40(5):343-73. doi: 10.2165/00003088-200140050-00003.

PubMed ID

11432537 [ View in PubMed

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Abstract

Combination of antimalarial agents has been introduced as a response to widespread drug resistance. The higher number of mutations required to express complete resistance against combinations may retard the further development of resistance. Combination of drugs, especially with the artemisinin drugs, may also offer complete and rapid eradication of the parasite load in symptomatic patients and thus reduce the chance of survival of resistant strains. The advantages of combination therapy should be balanced against the increased chance of drug interactions. During the last decade, much of the pharmacokinetics and metabolic pathways of antimalarial drugs have been elucidated, including the role of the cytochrome P450 (CYP) enzyme complex. Change in protein binding is not a significant cause of interactions between antimalarial agents. CYP3A4 and CYP2C19 are frequently involved in the metabolism of antimalarial agents. Quinidine is a potent inhibitor of CYP2D6, but it appears that this enzyme does not mediate the metabolism of any other antimalarial agent. The new combinations proguanil-atovaquone and chlorproguanil-dapsone do not show significant interactions. CYP2B6 and CYP3A4 are involved in the metabolism of artemisinin and derivatives, but further studies may reveal involvement of more enzymes. Artemisinin may induce CYP2C19. Several artemisinin drugs suffer from auto-induction of the first-pass effect, resulting in a decline of bioavailability after repeated doses. The mechanism of this effect is not yet clear, but induction by other agents cannot be excluded. The combination of artemisinin drugs with mefloquine and the fixed combination artemether-lumefantrine have been studied widely, and no significant drug interactions have been found. The artemisinin drugs will be used at an increasing rate, particularly in combination with other agents. Although clinical studies have so far not shown any significant interactions, drug interactions should be given appropriate attention when other combinations are used.

DrugBank Data that Cites this Article

Drug Enzymes

Drug	Enzyme	Kind	Organism	Pharmacological Action	Actions
Artemether	Cytochrome P450 2C19	Protein	Humans	Unknown	Substrate Inducer	Details

Drug Interactions

• Approved
• Vet approved
• Nutraceutical
• Illicit
• Withdrawn
• Investigational
• Experimental
• All Drugs

Drugs	Interaction
Integrate drug-drug interactions in your software
Amodiaquine Vemurafenib	The risk or severity of QTc prolongation can be increased when Vemurafenib is combined with Amodiaquine.
Artemether Vemurafenib	The risk or severity of QTc prolongation can be increased when Vemurafenib is combined with Artemether.
Artemotil Vemurafenib	The risk or severity of QTc prolongation can be increased when Vemurafenib is combined with Artemotil.
Artenimol Vemurafenib	The risk or severity of QTc prolongation can be increased when Vemurafenib is combined with Artenimol.
Artesunate Vemurafenib	The risk or severity of QTc prolongation can be increased when Vemurafenib is combined with Artesunate.