Did you get malaria pill side effects?

-m2-

There was a good article on artemisinin in the NY Times last month which, after Mike checked, we wouldn't have been able to use, even giving credit, without a stiff fee. I still have the article, so will condense the info a bit and post in this thread, it is a promising sounding solution. Personally, I don't use malaria prophlaxis as I travel in the winter and in places where there are few mosquitoes or malaria present so don't feel the risk warrants taking strong drugs with potentially nasty side effects over a prolonged period.

m2

-m2-

OK, here ya go:

After years of hesitation, world health agencies are racing to acquire 100 million doses of a Chinese herbal drug that has proved strikingly effective against malaria, one of the leading killers of the poor.

The drug, artemisinin, is a compound based on qinghaosu, or sweet wormwood. First isolated in 1965 by Chinese military researchers, it cut the death rate by 97 percent in a malaria epidemic in Vietnam in the early 1990's and It is rapidly replacing quinine derivatives and later drugs against which the disease has evolved into resistant strains. In order to protect artemisinin from the same fate, it will be given as part of multidrug cocktails.

Until recently, big donors like the United States and Britain had opposed its use on a wide scale, saying it was too expensive, had not been tested enough on children and was not needed in areas where other malaria drugs still worked and Unicef, which procures drugs for the world's poorest countries, opposed its use during an Ethiopian epidemic last year, saying that there was too little supply and that switching drugs in mid-outbreak would cause confusion.

But now almost all donors, Unicef and the World Bank have embraced the drug. The new Global Fund for AIDS, Tuberculosis and Malaria has given 11 countries grants to buy artemisinin and has instructed 34 others to drop requests for two older drugs — chloroquine and sulfadoxine-pyrimethamine — and switch to the new one. "We want countries to move very rapidly to use it as a first-line treatment," said Dr. Vinand Nantulya, the fund's malaria adviser and the fund expects to spend $450 million on the drug over the next five years, he said.

Like many tropical disease drugs, artemisinin is a fruit of military research. Chinese scientists first isolated it in 1965 while seeking a new antimalarial treatment for Vietnamese troops fighting American forces, said Dr. Nelson Tan, medical director of Holley Pharmaceuticals, which makes the drug in Chongqing, China. Another antimalarial drug still in use, mefloquine, was isolated at the Walter Reed Army Institute of Research in 1963 for American troops in the same jungles. Under the name Lariam, it is still issued to troops and sold to travelers.

Artemisinin, which has no significant side effects, quickly reduces fevers and rapidly lowers blood-parasite levels, which can keep small outbreaks in mosquito-infested areas from becoming epidemics. Two years ago, Dr. Dennis Carroll, a health adviser to the United States Agency for International Development, said artemisinin was "not ready for prime time." But on April 30 at a malaria conference at the Columbia University School of Public Health, he led a session on ways to induce farmers to plant more wormwood. Dr. Carroll said that more evidence had emerged that the drug was safe and that older drugs were not working.

Dr. Stewart Tyson, a health expert with the British Department for International Development, said his agency changed its opinion about the drug after its experience in Uganda, where resistance to older drugs had climbed to 31 percent in some areas in 2003 from 6 percent in 2000.

The price of artemisinin cocktails has fallen from $2 per treatment to 90 cents or less as more companies in China, India and Vietnam have begun making them. (Older drugs cost only 20 cents.) Novartis, the Swiss drug giant, sells its artemisinin-lumefantrine mix, Coartem, to poor countries for 10 cents less than it costs to make, a company official said. The same drug, under the name Riamet, is sold to European travelers for about $20. As a plant material, artemisinin cannot be patented, nor can the simple extraction process -- no doubt this puts off the big drug companies as patents=profits. No company has registered artemisinin in the United States, because sales would be too small to justify the cost of seeking approval from the Food and Drug Administration.

Now, with more large purchases in the offing, fears of a shortage that would push prices up are developing as he W.H.O. estimates 100 million doses will be needed by late 2005, and the world now has only about a third of that. Though it grows wild even in the United States, wormwood is cultivated only in China, Vietnam and pilot projects in Tanzania and India. It is planted in December and needs eight months to mature. And what Richard Allan, director of the Mentor Initiative, a public health group that fights malaria epidemics, called "the love of chloroquine" will have to be broken. That quinine derivative, in use since the 1950's, is now almost useless against parasites, but poor people still buy it because it is cheap and lowers fever as aspirin does....



so sue me

m2

edwardseco

There was a big write up on artemesin in the Wall Street Journal last year so that can be searched out. Shows early promise..

cyberhippie

Remember you heard it here first on IM

AvidTrekker

I just checked my drug index of Sept 2003. The full treatment (600mg) costs Rs 180. (US $ 4). Prices are bound to fall, or may have already fallen.

It mentions a patient alert : Be on alert for palpitatations and syncope as it may indicate heart block.

The adverse effects are also listed : one which I should mention is "Bradycardia, first degree AV block". Contraindicated in 1st trimester of pregnancy.

People with a heart problem and 1st trimester preg.females should avoid this one..... till further studies....

__________________
The Universe is an ellipsoid?... or a Spheroid?? If the sphere smiles... it becomes an ellipse. This IS Creation.

-m2-

Thanks for that, A_T; so is the treatment available in India at present? at regular pharmacies?

mushyosh

Yeah I would also like to know if I can get this stuff over the counter in India. Sounds better than the chemically alternatives.

Has anyone here tried it?

AvidTrekker

In my outdated drug-index, the drug names are written as artemether and artesunate. Both have into brackets (Antimalarial quinghaosu). So I guess it must be this artemisin only.

In India, everything (except maybe Potassium Cyanide) is available over the counter. No one is gonna ask for prescriptions. The manufacturers listed are : IPCA, MESCO, and Cadila HC... brand names are Larither, Arnate, and Falcigo respectively. I would trust Cadila (Falcigo) over the others ..... although IPCA and MESCO are well reputed. The chemists also have their own copy of the Drug-index. Ask for this book and read it. ALL the other "adverse effects". If I have the time. I'll fetch the latest one maybe today-tomorrow.

Both these are given as cocktails, never alone. Pre-decide your cocktail. Reccom. dosage for artemether/artesunate is :

Oral : Day 1 100mg BID; Day 2 to Day 5 : 50mg BID; Total 600mg

-m2-

I suspect since the treatment is so new, and with health authorities apparently trying to build up a stockpile, it is possible that the government might be hoarding supplies in order to allocate it to areas as needed and therefore could be difficult to find over-the-counter for now. Will be interested if you learn more on this A_T.

The article does mention that the treatment is available in Europe as 'Riamet' for 'about $20' -- which wouldn't be too bad for the full treatment, but I didn't notice any comment on how long the immunity would be effective for. If it lasts several months, this would be dandy -- if it does turn out to be difficult to obtain in India, then you could check for more info and availability at home before heading out.

-m2-

OOPS! I'm confusing treatment and propyhlaxis here. So now I'm thinking that this is what you bring along *in case you get malaria*, not to *prevent* it. I've heard of such a drug but had no details and I'm thinking that that is what this might be.

Can anyone help us out here??

AvidTrekker

I phoned up my chemist (local drugstore). He informed me that Falcigo and Larinate have both been shepherded into the "hospital pharmacy supply" list around six months ago. This means (in Mumbai at least) ONLY Pharmacies (drug stores) attached to major hospitals (there are more than hundred) will sell this AS PER PRESCRIPTION only. The last selling price around six months ago was Rs 98 for four tabs. Which means Rs 294 for the full 600 mg course (12 tabs). There seems to be a short supply... or rather exploding demand.

Hmmm.... so this has caught on.... but very much available! It is not difficult to get a prescription in Mumbai, folks !!

mushyosh

Wait Im kinda confused... Does this mean you take 12 tabs and then you can stop taking the pills, and you are covered for your whole trip?

1WorldinaCave

Hola,
Mushyosh, I think it's more likely that artemisinin is being used as a treatment for malaria infection rather than as a protection against infection.
Of course, it might well be suitable for use as a prophylactic, but I'm no doctor, and the websites I've found haven't been so clear.

Better to ask a doctor these questions.

vistet

I have no knowledge of this drug , but the general principles :

Synthetic or herbal drugs can not give immunity. To achieve immunity you must introduce a weaker variant of the micro-organism (bacteria , or in the case of malaria , protozo) that your immune system can neutralize. Once the immune system has done this , it can attack the intended micro-organism for the duration of its "memory".

AvidTrekker

The simple answer is, you can take artemisin AFTER you are infected. IMHO, there is no study to show that it will work as a preventive.