Does artesunate prolong the electrocardiograph QT interval in patients with severe malaria?
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.
Maude
Richard J
RJ
Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. richard@tropmedres.ac
Plewes
Katherine
K
Faiz
M Abul
MA
Hanson
Josh
J
Charunwatthana
Prakaykaew
P
Lee
Sue J
SJ
Tärning
Joel
J
Yunus
Emran Bin
EB
Hoque
M Gofranul
MG
Hasan
Mahatab Uddin
MU
Hossain
Amir
A
Lindegardh
Niklas
N
Day
Nicholas P J
NP
White
Nicholas J
NJ
Dondorp
Arjen M
AM
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
D000962:Antimalarials; D037621:Artemisinins; D004983:Ethanolamines; D005449:Fluorenes; D000077332:Artesunate; D000078102:Lumefantrine