title: The pharmacokinetics of artemether and lumefantrine in pregnant women with uncomplicated falciparum malaria.
abstract: OBJECTIVE
  To determine the pharmacokinetic properties of artemether and lumefantrine (AL) in pregnant women with recrudescent uncomplicated multi-drug resistant falciparum malaria.
  
  
  METHODS
  Pregnant women who had recurrence of parasitaemia following 7 days supervised quinine treatment were treated with AL. Serial blood samples were taken over a 7-day period, and pharmacokinetic parameters were estimated. For lumefantrine, these data were compared in a population pharmacokinetic model with data from non-pregnant, mainly male adults with acute malaria.
  
  
  RESULTS
  The pregnant women (five in the second trimester and eight in the third trimester) had lower concentrations of artemether, dihydroartemisinin and lumefantrine, and the elimination of lumefantrine in pregnant women was more rapid than reported previously in non-pregnant adults.
  
  
  CONCLUSIONS
  Pregnancy is associated with reduced plasma concentrations of both artemether and lumefantrine. This is likely to be of therapeutic significance as plasma concentrations of lumefantrine, after elimination of artemether, are an important determinant of cure. Further studies are needed to determine the optimum dose regimen of artemether-lumefantrine in pregnancy.
authors.affiliation: Shoklo Malaria Research Unit, P.O. Box 46, Mae Sot, Tak, Thailand.
authors.forename: Rose
authors.initials: R
authors.lastname: McGready
authors.forename: Kasia
authors.initials: K
authors.lastname: Stepniewska
authors.forename: Niklas
authors.initials: N
authors.lastname: Lindegardh
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Ashley
authors.forename: Yar
authors.initials: Y
authors.lastname: La
authors.forename: Pratap
authors.initials: P
authors.lastname: Singhasivanon
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: François
authors.initials: F
authors.lastname: Nosten
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D019540:Area Under Curve; D000077549:Artemether; D037621:Artemisinins / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004983:Ethanolamines / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D005260:Female; D005449:Fluorenes / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D005500:Follow-Up Studies; D006207:Half-Life; D006801:Humans; D000078102:Lumefantrine; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000378:metabolism*; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second / Q000378:metabolism; D011263:Pregnancy Trimester, Third / Q000378:metabolism; D012008:Recurrence; D012074:Remission Induction; D012717:Sesquiterpenes / Q000097:blood; D013607:Tablets; D013785:Thailand
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004983:Ethanolamines; D005449:Fluorenes; D012717:Sesquiterpenes; D013607:Tablets; C039060:artenimol; D000077549:Artemether; D000078102:Lumefantrine