Artemether

Artemether is an antimalarial drug for uncomplicated malaria caused by  P. falciparum (and chloroquine-resistant P. falciparum) or chloroquine-resistant P. vivax parasites. Artemether can also be used to treat severe malaria. Given in combination with lumefantrine, it may be followed by a 14-day regimen of primaquine to prevent relapse of P. vivax or P. ovale malarial parasites and provide a complete cure. Artemether can also be used in treating and preventing trematode infections of schistosomiasis when used in combination with praziquantel. Artemether is rated category C by the FDA based on animal studies where artemisinin derivatives have shown an association with fetal loss and deformity. Some studies, however, do not show evidence of harm. == Side effects ==

Possible side effects include cardiac effects such as bradycardia and QT interval prolongation. Also, possible central nervous system toxicity has been shown in animal studies. == Drug interactions ==

Plasma artemether level was found to be lower when the combination product was used with lopinavir/ritonavir. Artemether/lumefantrine should not be used with drugs that inhibit CYP3A4. Hormonal contraceptives may not be as efficacious when used with artemether/lumefantrine. ==Pharmacology==

Mechanism of action A possible mechanism of action is that artemisinin drugs exert their cidal action by inhibiting PfATP6. Since PfATP6 is an enzyme regulating cellular calcium concentration, its malfunctioning will lead to intracellular calcium accumulation, which in turns causes cell death. Pharmacokinetics Absorption of artemether is improved 2- to 3-fold with food. It is highly bound to protein (95.4%). Peak concentrations of artemether are seen 2 hours after administration. Artemether is metabolized in the human body to the active metabolite, dihydroartemisinin, primarily by hepatic enzymes CYP3A4/5. Both the parent drug and active metabolite are eliminated with a half-life of about 2 hours. ==Chemistry==

Artemether is a methyl ether derivative of artemisinin, which is a peroxide-containing lactone isolated from the antimalarial plant Artemisia annua. It is also known as dihydroartemisinin methyl ether, but its correct chemical nomenclature is (+)-(3α,5aβ,6β,8aβ,9α,12β,12aR)-decahydro-10-methoxy-3,6,9-trimethyl-3,12-epoxy-12H-pyrano[4,3-j]-1,2-benzodioxepine. It is a relatively lipophilic and unstable drug, which acts by creating reactive free radicals in addition to affecting the membrane transport system of the plasmodium organism. == References ==