title: Pharmacokinetic profiles of artesunate following multiple intravenous doses of 2, 4, and 8 mg/kg in healthy volunteers: phase 1b study.
abstract: BACKGROUND
  Severe malaria results in over a million deaths every year, most of them in children aged less than five years and living in sub-Saharan Africa. Injectable artesunate (AS) was recommended as initial treatment for severe malaria by WHO in 2006. The Walter Reed Army Institute of Research (WRAIR) has been developing a novel good manufacturing practice (GMP) injection of AS, which was approved by the US FDA for investigational drug use and distribution by the CDC.
  
  
  METHODS
  Tolerability and pharmacokinetics of current GMP intravenous AS, as an anti-malarial agent, were evaluated after ascending multiple doses of 2, 4, and 8 mg/kg daily for three days with 2-minute infusion in 24 healthy subjects (divided into three groups) in the Phase 1 clinical trial study.
  
  
  RESULTS
  Results showed that there were no dose-dependent increases in any adverse events. Drug concentrations showed no accumulation and no decline of the drug during the three days of treatment. After intravenous injection, parent drug rapidly declined and was converted to dihydroartemisinin (DHA) with overall mean elimination half-lives ranging 0.15-0.23 hr for AS and 1.23-1.63 hr for DHA, but the peak concentration (C(max)) of AS was much higher than that of DHA with a range of 3.08-3.78-folds. In addition, the AUC and C(max) values of AS and DHA were increased proportionally to the AS climbing multiple doses.
  
  
  CONCLUSIONS
  The safety of injectable AS, even at the highest dose of 8 mg/kg increases the probability of therapeutic success of the drug even in patients with large variability of parasitaemia.
authors.affiliation: US Army Medical Material Development Activity, Ft Detrick, MD, USA.
authors.forename: Robert Scott
authors.initials: RS
authors.lastname: Miller
authors.forename: Qigui
authors.initials: Q
authors.lastname: Li
authors.forename: Louis R
authors.initials: LR
authors.lastname: Cantilena
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Leary
authors.forename: George A
authors.initials: GA
authors.lastname: Saviolakis
authors.forename: Victor
authors.initials: V
authors.lastname: Melendez
authors.forename: Bryan
authors.initials: B
authors.lastname: Smith
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Weina
mesh_terms: D000328:Adult; D000349:Africa; D000962:Antimalarials / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics*; D037621:Artemisinins / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics*; D000077332:Artesunate; D003188:Composite Resins; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010919:Placebos / Q000008:administration & dosage; D014481:United States; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D003188:Composite Resins; D010919:Placebos; C546490:Profil; D000077332:Artesunate