title: Does artesunate prolong the electrocardiograph QT interval in patients with severe malaria?
abstract: Several antimalarials can cause significant prolongation of the electrocardiograph QT interval, which can be associated with an increased risk of potentially lethal ventricular arrhythmias. High doses of artemether and artemotil have been associated with QT prolongation in dogs, raising the possibility of a class effect with the artemisinin derivatives. Serial electrocardiograms were recorded, and QTc interval was calculated before and after administration of artesunate by intravenous injection in patients with severe falciparum malaria in Bangladesh. Of 21 adult patients with severe malaria enrolled, 8 (38%) died. The mean QTc interval was unaffected by bolus intravenous artesunate (2.4 mg/kg). In two patients, the QTc interval exceeded 0.5 seconds, but in both cases, an alternative explanation was plausible. No effect was observed on the JTc or PR interval, QRS width, blood pressure, or heart rate. Intravenous artesunate does not have significant cardiovascular effects in patients with severe falciparum malaria.
authors.affiliation: Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. richard@tropmedres.ac
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Maude
authors.forename: Katherine
authors.initials: K
authors.lastname: Plewes
authors.forename: M Abul
authors.initials: MA
authors.lastname: Faiz
authors.forename: Josh
authors.initials: J
authors.lastname: Hanson
authors.forename: Prakaykaew
authors.initials: P
authors.lastname: Charunwatthana
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Joel
authors.initials: J
authors.lastname: Tärning
authors.forename: Emran Bin
authors.initials: EB
authors.lastname: Yunus
authors.forename: M Gofranul
authors.initials: MG
authors.lastname: Hoque
authors.forename: Mahatab Uddin
authors.initials: MU
authors.lastname: Hasan
authors.forename: Amir
authors.initials: A
authors.lastname: Hossain
authors.forename: Niklas
authors.initials: N
authors.lastname: Lindegardh
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: Arjen M
authors.initials: AM
authors.lastname: Dondorp
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D037621:Artemisinins / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000077332:Artesunate; D001794:Blood Pressure / Q000187:drug effects; D004562:Electrocardiography / Q000187:drug effects*; D004983:Ethanolamines / Q000627:therapeutic use; D005449:Fluorenes / Q000627:therapeutic use; D015600:Glasgow Coma Scale; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000517:prevention & control; D000078102:Lumefantrine; D008288:Malaria / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D018579:Patient Selection
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004983:Ethanolamines; D005449:Fluorenes; D000077332:Artesunate; D000078102:Lumefantrine